Information Collection

MSInteractive Survey Tool for www.medicare.gov

IC 8471 under ICR 201107-0938-016 · OMB 0938-0756.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0756 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-R-268 MSInteractive Survey Tool for www.medicare.gov Form and Instruction
CMS-R-268 MSIInteractive Survey tool for www.,edicare.gov CMS-R-268.REVISED- Collection_Instrument_12-03-10[1].pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	MSInteractive Survey Tool for www.medicare.gov	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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
Form and Instruction	CMS-R-268	MSIInteractive Survey tool for www.,edicare.gov	CMS-R-268.REVISED- Collection_Instrument_12-03-10[1].pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,900	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	4,900	4,900
Annual IC Time Burden (Hours)	817	817
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.