Information Collection

1-800 MEDICARE Beneficiary Satisfaction Survey (Outbound Telephone Survey)

IC 196719 under ICR 201103-0938-003 · OMB 0938-0919.

Documents and Forms

Document Name Document Type
OMB Form 83 - Part II Worksheet (Outbound Telephone)-2.doc Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	1-800 MEDICARE Beneficiary Satisfaction Survey (Outbound Telephone Survey)	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 Form 83 - Part II Worksheet (Outbound Telephone)-2.doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 14,700	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	14,700	14,700
Annual IC Time Burden (Hours)	2,684	2,684
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.