Marketplace Survey Data Collection

Health Insurance Marketplace Consumer Experience Surveys: Enrollee Satisfaction Survey and Marketplace Survey Data Collection (CMS-10488)

⚠️ Notice: This information collection may be referencing outdated material.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 Marketplace Survey for Beta Test English Marketplace Survey for Beta Test_Spanish_12_11_14_CLEAN_508.pdf Form and Instruction
CMS-10488 Marketplace Survey for the Beta Test English CMS-10488 - Marketplace Survey for Beta Test_English_12_11_14_CLEAN_508 - Copy.pdf Form and Instruction
CMS-10488 Marketplace Survey for Beta Test Chinese CMS-10488 Marketplace Survey for Beta Test_Chinese_12_11_14_CLEAN_508.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	Marketplace Survey for Beta Test English	Marketplace Survey for Beta Test_Spanish_12_11_14_CLEAN_508.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10488	Marketplace Survey for the Beta Test English	CMS-10488 - Marketplace Survey for Beta Test_English_12_11_14_CLEAN_508 - Copy.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10488	Marketplace Survey for Beta Test Chinese	CMS-10488 Marketplace Survey for Beta Test_Chinese_12_11_14_CLEAN_508.pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 52,800	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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	52,800	-11,550	64,350
Annual IC Time Burden (Hours)	12,672	-13,068	25,740
Annual IC Cost Burden (Dollars)	0	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.