1-800 MEDICARE Beneficiary Satisfaction Survey (Web Chat)

1-800-MEDICARE Beneficiary Satisfaction Survey (CMS-100098)

Documents and Forms

Document Name Document Type
OMB E-mail and Web Chat Survey (1).docx Instruction

Information Collection (IC) Details

IC Title:	1-800 MEDICARE Beneficiary Satisfaction Survey (Web Chat)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			OMB E-mail and Web Chat Survey (1).docx		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,568	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,568	2,568
Annual IC Time Burden (Hours)	342	342
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.