Beneficiary Contact Center Customer Satisfaction Survey

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1185 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10415 Beneficiary Contact Center Customer Satisfaction Survey Form and Instruction
CMS-10415 IVR Phone Script for Survey OMB IVR Phone Script 2013.docx Form and Instruction
BCC Satisfaction Survey Submission form.doc BCC Satisfaction Survey Submission form IC Document

Information Collection (IC) Details

IC Title:	Beneficiary Contact Center Customer Satisfaction Survey	Agency IC Tracking Number:

IC Status: Unchanged

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-10415	IVR Phone Script for Survey	OMB IVR Phone Script 2013.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 145,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	145,000	145,000
Annual IC Time Burden (Hours)	5,776	5,776
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
BCC Satisfaction Survey Submission form	BCC Satisfaction Survey Submission form.doc	06/18/2013

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