GenIC # 4: Web Intercept Survey of HealthCare.gov Visitors

Generic Social Marketing & Consumer Testing Research

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1247 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10437-GenIC#4 GenIC # 4: Web Intercept Survey of HealthCare.gov Visitors Form and Instruction
CMS-10437-GenIC#4 Web Intercept Survey of HealthCare.gov Visitors CMS-10437#4 -Instrument with disclosure statement.pdf Form and Instruction
CMS-10437. GenIC#4 -Mini Supporting Statement.docx CMS-10437. GenIC#4 -Mini Supporting Statement IC Document

Information Collection (IC) Details

IC Title:	GenIC # 4: Web Intercept Survey of HealthCare.gov Visitors	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10437-GenIC#4	Web Intercept Survey of HealthCare.gov Visitors	CMS-10437#4 -Instrument with disclosure statement.pdf		Yes	Yes	Fillable Fileable Signable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 14,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	14,000	14,000
Annual IC Time Burden (Hours)	933	933
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
CMS-10437. GenIC#4 -Mini Supporting Statement	CMS-10437. GenIC#4 -Mini Supporting Statement.docx	11/04/2015

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.