Individual Survey

Consumer Research Supporting Outreach for Health Insurance Marketplace

OMB: 0938-1203

IC ID: 206915

Documents and Forms
Information Collection (IC) Details

View Information Collection (IC)

Individual 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-10458 Individual Survey CMS-10458_Individual_Marketplace_Tracking_Survey_(REVISED).pdf Yes No Fillable Fileable

Health Health Care Services

 

1,500 0
   
Individuals or Households
 
   33 %

  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 6,000 6,000 0 0 0 0
Annual IC Time Burden (Hours) 1,200 1,200 0 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.

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