2015 976 CMS-CGS DME MAC B Questionnaire 6.9.16

E-Government Website Customer Satisfaction Surveys

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1090-0008 can be found here:

Documents and Forms

Document Name Document Type
Form 976 2015 976 CMS-CGS DME MAC B Questionnaire 6.9.16 Form and Instruction
976 2015 976 CMS-CGS DME MAC B Questionnaire 6.9.16 2015 976 CMS-CGS DME MAC B Questionnaire 6.9.16.xlsx Form and Instruction

Information Collection (IC) Details

IC Title:	2015 976 CMS-CGS DME MAC B Questionnaire 6.9.16	Agency IC Tracking Number:	976

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	976	2015 976 CMS-CGS DME MAC B Questionnaire 6.9.16	2015 976 CMS-CGS DME MAC B Questionnaire 6.9.16.xlsx		Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,600	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,600	3,600
Annual IC Time Burden (Hours)	150	150
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.