GenIC#14 - Medicare Beneficiary Consumer Survey

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⚠️ Notice: This information collection may be referencing outdated material.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# GenIC#14 - Medicare Beneficiary Consumer Survey Form and Instruction
CMS-10437 - GenIC# Medicare Beneficiary Consumer Survey CMS-10437.GenIC14_Medicare Beneficiary Consumer Survey_Instrument.docx Form and Instruction
CMS-10437. GenIC#14_Medicare Beneficiary Consumer Survey_SupportingStatement.docx CMS-10437. GenIC#14_Medicare Beneficiary Consumer Survey_SupportingStatement IC Document
CMS-10437.GenIC14_Medicare Beneficiary Consumer Survey_CoverPage.docx CMS-10437.GenIC14_Medicare Beneficiary Consumer Survey_CoverPage IC Document

Information Collection (IC) Details

IC Title:	GenIC#14 - Medicare Beneficiary Consumer Survey	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#14	Medicare Beneficiary Consumer Survey	CMS-10437.GenIC14_Medicare Beneficiary Consumer Survey_Instrument.docx		Yes	No	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,800	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4,800	4,800
Annual IC Time Burden (Hours)	1,200	1,200
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
CMS-10437. GenIC#14_Medicare Beneficiary Consumer Survey_SupportingStatement	CMS-10437. GenIC#14_Medicare Beneficiary Consumer Survey_SupportingStatement.docx	06/06/2017
CMS-10437.GenIC14_Medicare Beneficiary Consumer Survey_CoverPage	CMS-10437.GenIC14_Medicare Beneficiary Consumer Survey_CoverPage.docx	06/06/2017

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