Information Collection Request

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

ICR 201508-0938-007 · OMB 0938-1221 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10488 Marketplace Survey Data Collection Form and Instruction Removed Available
Form CMS-10488 Adult Qualified Health Plan Enrollee Experience Survey Form and Instruction Modified Available
CMS-10488 - BCBSA comment response.docx Supplementary Document Uploaded 2015-09-10 Available
CMS-10488 - 60-Day Response to Comment 71315.xlsx Supplementary Document Uploaded 2015-08-07 Available
QHP Survey_Revisions Crosswalk_071315_final.pdf Supplementary Document Uploaded 2015-08-07 Available
CMS-10488 - QHP Survey_SS Part B_Clean.docx Supporting Statement B Uploaded 2015-09-10 Available
CMS-10488 - QHP Survey_SS Part A Clean.docx Supporting Statement A Uploaded 2015-09-10 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
210331 Marketplace Survey Data Collection Form and Instruction Removed
210330 Adult Qualified Health Plan Enrollee Experience Survey Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
09/30/2018 36 Months From Approved 02/28/2017
120,015 0 232,810
39,623 0 70,282
0 0 0





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table that charts list of burden
IC Title Form No. Form Name
Marketplace Survey Data Collection CMS-10488, CMS-10488, CMS-10488 Marketplace Survey for Beta Test English ,   Marketplace Survey for the Beta Test English ,   Marketplace Survey for Beta Test Chinese
Adult Qualified Health Plan Enrollee Experience Survey CMS-10488, CMS-10488, CMS-10488, CMS-10488, CMS-10488, CMS-10488, CMS-10488 Survey Vendor Application ,   QHP Survey (Chinese) ,   Cover Letter (Chinese) ,   QHP Survey (English) ,   Cover Letter (English) ,   QHP Survey (Spanish) ,   Cover Letter (Spanish)

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 120,015 232,810 0 -52,800 -59,995 0
Annual Time Burden (Hours) 39,623 70,282 0 -12,672 -17,987 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


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