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

Parts C and D Complaints Resolution Performance Measures

Documents and Forms

Document Name Document Type
Form CMS-10308 Parts C and D Complaints Resolution Performance Measures (CMS-10308) Form and Instruction
CMS-10308 Complaints Resolution Survey (Spanish) CROY2_WebBasedSurvey_SpanishScreenshots_130129.pdf Form and Instruction
CMS-10308 Complaints Resolution Survey (English) CROY2_WebBasedSurvey_Screenshots_121218.pdf Form and Instruction
6401 OMB Explanations for Inclusion of Survey Questions 100202.pdf Explaination of Survey Questions IC Document
CROSSWALK - Changes to Advance Letter, Supporting Statements A and B, Survey Instrument, and Frequently Asked Questions.docx CROSSWALK - Changes to Advance Letter, Supporting Statements A and B, Survey Instrument, and Frequently Asked Questions IC Document

Information Collection (IC) Details

IC Title:	Parts C and D Complaints Resolution Performance Measures (CMS-10308)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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-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

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 59,032	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 97 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	18,210	12,910	5,300
Annual IC Time Burden (Hours)	3,035	2,151	884
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.