Marketplace Survey Data Collection

Health Insurance Marketplace Consumer Experience Surveys: Enrollee Satisfaction Survey and Marketplace Survey Data Collection

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1221 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10488 Marketplace Survey Data Collection Form and Instruction
CMS-10488 English - Marketplace Survey English Marketplace Survey after OMB NCHS review_clean_2-6-2014_CMS (2).docx Form and Instruction
CMS-10488 Spanish - Marketplace Survey CMS-10488 - Marketplace Survey_Spanish.pdf Form and Instruction
CMS-10488 Chinese - Marketplace Survey CMS-10488 - Marketplace Survey_Chinese.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Marketplace Survey Data Collection	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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10488	English - Marketplace Survey	English Marketplace Survey after OMB NCHS review_clean_2-6-2014_CMS (2).docx	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10488	Spanish - Marketplace Survey	CMS-10488 - Marketplace Survey_Spanish.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10488	Chinese - Marketplace Survey	CMS-10488 - Marketplace Survey_Chinese.pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 64,350	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	64,350	64,350
Annual IC Time Burden (Hours)	25,740	25,740
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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