Parts C and D Complaints Resolution Performance Measures (CMS-10308)

Parts C and D Complaints Resolution Performance Measures

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1107 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10308 Parts C and D Complaints Resolution Performance Measures (CMS-10308) Form and Instruction
CMS-10308 CMS-10308.Revised Survey Instrument CMS-10308.Revised Survey Instrument.doc Form and Instruction
CMS-10308 Parts C and D Complaint Closure Beneficiary Survey CR_OMB SurveyInstrument 100520.pdf Form and Instruction
CMS-10308 Parts C and D Complaint Closure Beneficiary Survey (8-6- CR_OY_SurveyInstrument_revisedclean.doc Form and Instruction
CR_OMB Advance Letter 100520.pdf CR_OMB Advance Letter 100520 IC Document
CR_OMB Explanations for Inclusion of Survey Qs 100520.pdf CR_OMB Explanations for Inclusion of Survey Qs 100520 IC Document

Information Collection (IC) Details

IC Title:	Parts C and D Complaints Resolution Performance Measures (CMS-10308)	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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10308	CMS-10308.Revised Survey Instrument	CMS-10308.Revised Survey Instrument.doc	No	No	Paper Only
Form and Instruction	CMS-10308	Parts C and D Complaint Closure Beneficiary Survey	CR_OMB SurveyInstrument 100520.pdf	No	No	Paper Only
Form and Instruction	CMS-10308	Parts C and D Complaint Closure Beneficiary Survey (8-6-12)	CR_OY_SurveyInstrument_revisedclean.doc	No	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 5,300	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 90 %

	Approved	Previously Approved
Annual Number of Responses for this IC	5,300	5,300
Annual IC Time Burden (Hours)	884	884
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
CR_OMB Advance Letter 100520	CR_OMB Advance Letter 100520.pdf	06/10/2010
CR_OMB Explanations for Inclusion of Survey Qs 100520	CR_OMB Explanations for Inclusion of Survey Qs 100520.pdf	06/10/2010

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