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Federal forms, ICRs, and supporting documents

Information Collection

Medicare Advantage Quality Bonus Payment Demonstration MAO mail survey

IC 206030 under ICR 201303-0938-002 · OMB 0938-1195.

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

View Information Collection (IC)

Medicare Advantage Quality Bonus Payment Demonstration MAO mail survey
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10445 Initial Call Form Appendix C_Initial Call Form.docx Yes Yes Fillable Fileable
Form and Instruction CMS-10445 Reminder Call Script Appendix D_Reminder Call Script.docx Yes Yes Fillable Fileable
Form and Instruction CMS-10445 QBP MAO Survey QBP MAO Survey_02.01.2013_508.docx Yes Yes Fillable Fileable

Health Health Care Services

 

620 0
   
Private Sector Businesses or other for-profits
 
   90 %

  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 620 620 0 0 0 0
Annual IC Time Burden (Hours) 610 610 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
FAQ Appendix E_FAQ.docx 02/25/2013
Letters to health plans Appendix B_Letters to health plans.docx 02/25/2013
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.