Information Collection Request

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

ICR 201610-0938-003 · OMB 0938-1221 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10488 Adult Qualified Health Plan Enrollee Experience Survey Form and Instruction Unchanged Available
CMS-10488 - 2017 QHP Survey_Part A_clean.DOCX Supporting Statement A Uploaded 2016-10-25 Available
CMS-10488 - 2017 QHP Survey_NonSubstantiveChangeJustification.docx Justification for No Material/Nonsubstantive Change Uploaded 2016-10-18 Available
CMS-10488 - QRS Bulletin.pdf Supplementary Document Uploaded 2016-09-19 Available
CommentResponse.docx Supplementary Document Uploaded 2016-07-14 Available
CMS-10488 - English_2017_QHP_Survey TC.docx Supplementary Document Uploaded 2016-07-14 Repair queued
CMS-10488 - 2017 QHP Survey_Part B_clean.docx Supporting Statement B Uploaded 2016-09-19 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
210330 Adult Qualified Health Plan Enrollee Experience Survey Form and Instruction Unchanged

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
09/30/2017 09/30/2017 09/30/2017
105,015 0 105,015
37,823 0 37,823
0 0 0





Reginfo record details
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table that charts list of burden
IC Title Form No. Form Name
Adult Qualified Health Plan Enrollee Experience Survey CMS-10488, CMS-10488, CMS-10488, CMS-10488, CMS-10488, CMS-10488, CMS-10488 Survey Vendor Application ,   2017 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 105,015 105,015 0 0 0 0
Annual Time Burden (Hours) 37,823 37,823 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
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