Information Collection

Senior Medicare Program National Beneficiary Survey

IC 225707 under ICR 201702-0985-003 · OMB 0985-0056.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0985-0056 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Senior Medicare Program National Beneficiary Survey Form
1 Senior Medicare Patrol Comment Card Survey ACL_SMP-Comment-Card-Survey.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Senior Medicare Program National Beneficiary Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	1	Senior Medicare Patrol Comment Card Survey	ACL_SMP-Comment-Card-Survey.pdf		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,325	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,325	1,325
Annual IC Time Burden (Hours)	110	110
Annual IC Cost Burden (Dollars)	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.