Information Collection

Medicare Advantage and Medicare Fee-For-Service CAHPS Survey: MA & PDP Plan Burden

IC 194256 under ICR 201110-0938-001 · OMB 0938-0732.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0732 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-R-246 Medicare Advantage and Medicare Fee-For-Service CAHPS Survey: MA & PDP Plan Burden	Form and Instruction
CMS-R-246 MA-PDP Survey MA-PDP Survey.pdf	Form and Instruction

IC Title:

Medicare Advantage and Medicare Fee-For-Service CAHPS Survey: MA & PDP Plan Burden

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 422.152 42 CFR 422.156 42 CFR 417.472

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-R-246	MA-PDP Survey	MA-PDP Survey.pdf		No	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: Privacy Act of 1974: HPMS # 09-70-4004

FR Citation: 63 FR 43187

Number of Respondents: 609

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 25 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	609	-15	624
Annual IC Time Burden (Hours)	32,886	-810	33,696
Annual IC Cost Burden (Dollars)	3,045,000	-75,000	3,120,000

Documents for IC

table that charts IC Documents
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.