OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Parts C and D Complaints Resolution Performance Measures (CMS-10308)

IC 193233 under ICR 201307-0938-021 · OMB 0938-1107.

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

View Information Collection (IC)

Parts C and D Complaints Resolution Performance Measures (CMS-10308)
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10308 Complaints Resolution Survey (Spanish) CROY2_WebBasedSurvey_SpanishScreenshots_130129.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10308 Complaints Resolution Survey (English) CROY2_WebBasedSurvey_Screenshots_121218.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

59,032 0
   
Individuals or Households
 
   97 %

  Requested 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 18,210 0 12,910 0 0 5,300
Annual IC Time Burden (Hours) 3,035 0 2,151 0 0 884
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Explaination of Survey Questions 6401 OMB Explanations for Inclusion of Survey Questions 100202.pdf 07/25/2013
CROSSWALK - Changes to Advance Letter, Supporting Statements A and B, Survey Instrument, and Frequently Asked Questions CROSSWALK - Changes to Advance Letter, Supporting Statements A and B, Survey Instrument, and Frequently Asked Questions.docx 07/25/2013
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.