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Federal forms, ICRs, and supporting documents

Information Collection

Reporting for the Health Insurance Marketplace and Qualified Health Plan Enrollee Experience Surveys: Health Insurance Marketplace Consumer Experience Surveys Project

IC 212695 under ICR 201210-0938-003 · OMB 0938-1185.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Reporting for the Health Insurance Marketplace and Qualified Health Plan Enrollee Experience Surveys: Health Insurance Marketplace Consumer Experience Surveys Project
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10534 Cognitive Interview Guide, Screener and Consent Forms Report Task Attachments081814.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

90 15
   
Private Sector Businesses or other for-profits
 
   0 %

  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 90 0 90 0 0 0
Annual IC Time Burden (Hours) 106 0 106 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Reporting for the Health Insurance Marketplace and Qualified Health Plan Enrollee Experience Surveys Generic Clearance Submission_Report_v4_clean.docx 08/18/2014
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.