Medicare Disenrollee Survey - MA (CMS-10316)

Implementation of the Medicare Prescription Drug Plan (PDP) and Medicare

OMB: 0938-1113

IC ID: 207675

Information Collection (IC) Details

View Information Collection (IC)

Medicare Disenrollee Survey - MA (CMS-10316)
 
No New
 
Voluntary
 
42 CFR 423.156

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-10316 Medicare Disenrollee Survey - MA Attachment 5 - MA Only Survey.docx No No Fillable Printable

Health Health Care Services

 

6,870 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 6,870 0 6,870 0 0 0
Annual IC Time Burden (Hours) 1,443 0 1,443 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Attachment 1 - PRE NOTIFICATION LETTERS Attachment 1 - PRE NOTIFICATION LETTERS.docx 07/08/2013
Attachment 2 - SURVEY COVER LETTERS Attachment 2 - SURVEY COVER LETTERS.docx 07/08/2013
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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