SHOP Satisfaction Surveys

Small Business Health Options Program (SHOP) Effective Date and Termination Notice Requirements (CMS-10555)

OMB: 0938-1303

IC ID: 219294

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

SHOP Satisfaction Surveys
 
No New
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10555 SHOP Notices Agents-Brokers Survey CMS-10555 - Attachment 1 SHOP Notices Agents-Brokers Survey.docx Yes No Fillable Fileable
Form and Instruction CMS-10555 SHOP Notices - Employer Survey CMS-10555 - Attachment 2 SHOP Notices Employer Survey.docx Yes No Fillable Fileable
Form and Instruction CMS-10555 SHOP Notices - Employee Survey.docx CMS-10555 - Attachment 3 SHOP Notices Employee Survey.docx Yes No Fillable Fileable

Health Health Care Services

 

2,440 0
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 4,880 4,880 0 0 0 0
Annual IC Time Burden (Hours) 2,440 2,440 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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