Information Collection

Marketplace Survey Data Collection

IC 210331 under ICR 201409-0938-006 · OMB 0938-1221.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10488 Marketplace Survey Data Collection	Form and Instruction
CMS-10488 Marketplace Survey - Chinese CMS-10488 - Marketplace Survey_Chinese.pdf	Form and Instruction
CMS-10488 Marketplace Survey Spanish CMS-10488 - Marketplace Survey_Spanish.pdf	Form and Instruction
CMS-10488 Marketplace Survey English CMS-10488 - Marketplace Survey English.docx	Form and Instruction

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10488	Marketplace Survey - Chinese	CMS-10488 - Marketplace Survey_Chinese.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10488	Marketplace Survey Spanish	CMS-10488 - Marketplace Survey_Spanish.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10488	Marketplace Survey English	CMS-10488 - Marketplace Survey English.docx	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 %

table that charts list of burden
	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

table that charts IC Documents
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.