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Medicare Advantage and Medicare Fee-For-Service CAHPS Survey: Stand Alone PDP Survey (CMS-R-246)
Medicare Advantage and Medicare Fee-For-Service Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey
OMB: 0938-0732
IC ID: 194258
OMB.report
HHS/CMS
OMB 0938-0732
ICR 201110-0938-001
IC 194258
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0732 can be found here:
2024-06-25 - Revision of a currently approved collection
2023-05-05 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
Form CMS-R-246
Medicare Advantage and Medicare Fee-For-Service CAHPS Survey: Stand Alone PDP Survey (CMS-R-246)
Form and Instruction
CMS-R-246 Stand Alone PDP Survey
Stand Alone PDP Survey.pdf
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Medicare Advantage and Medicare Fee-For-Service CAHPS Survey: Stand Alone PDP Survey (CMS-R-246)
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Voluntary
CFR Citation:
42 CFR 423.156
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-246
Stand Alone PDP Survey
Stand Alone PDP Survey.pdf
No
No
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
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:
81,000
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
25 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
112,500
0
31,500
0
0
81,000
Annual IC Time Burden (Hours)
28,125
0
7,875
0
0
20,250
Annual IC Cost Burden (Dollars)
0
0
0
0
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.