Medicare Plan Finder Experiment

Medicare Plan Finder Experiment

OMB: 0938-1201

IC ID: 205057

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

View Information Collection (IC)

Medicare Plan Finder Experiment
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10441 Attachment_E-a Attachment_E-a.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10441 Attachment J - post survey conditions 3 and 4 - 100112 Attachment J - post survey conditions 3 and 4 - 100112.pdf No Yes Fillable Fileable
Form and Instruction CMS-10441 Attachment L - post survey conditions 7 and 8 Attachment L - post survey conditions 7 and 8 - 100112.pdf No No Fillable Fileable
Form and Instruction CMS-10441 Attachment N - post survey conditions 11 and 12 Attachment N - post survey conditions 11 and 12 - 100112.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10441 Attachment_B-a Attachment_B-a.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10441 Attachment_C-a Attachment_C-a.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10441 Attachment_A-a Attachment_A-a.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10441 Attachment_D-a Attachment_D-a.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10441 Attachment_F-a Attachment_F-a.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10441 Attachment_G-a Attachment_G-a.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10441 Attachment H - pre-exposure survey 100112 Attachment H - pre-exposure survey 100112.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10441 Attachment_I-post_survey_conditions_1_and_2 Attachment_I-post_survey_conditions_1_and_2_508_083112.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10441 Attachment K - post survey conditions 5 and 6 Attachment K - post survey conditions 5 and 6 - 100112.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10441 Attachment M - post survey conditions 9 and 10 Attachment M - post survey conditions 9 and 10 100112.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10441 Attachment O - post survey conditions 13 and 14 Attachment O - post survey conditions 13 and 14 - 100112.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10441 Attachment P - post survey conditions 15 and 16 Attachment P - post survey conditions 15 and 16 - 100112.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

600 0
   
Individuals or Households
 
   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 600 0 600 0 0 0
Annual IC Time Burden (Hours) 252 0 252 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.

© 2024 OMB.report | Privacy Policy