MA-PDP Survey

Medicare Advantage, Medicare Part D, and Medicare Fee-For-Service Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey (CMS-R-246)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0732 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-R-246 MA-PDP Survey Form and Instruction
CMS-R-246 Prescription Drug Plan Survey MA-PD_Survey_2017.docx Form and Instruction
MA-PD_survey_crosswalk_2017.docx Crosswalk - Prescription Drug Plan Survey IC Document

Information Collection (IC) Details

IC Title:	MA-PDP Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 423.156

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-R-246	Prescription Drug Plan Survey	MA-PD_Survey_2017.docx		No		Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: Privacy Act of 1974: HPMS # 09-70-4004	FR Citation: 63 FR 43187

Number of Respondents: 97,500	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	Previously Approved
Annual Number of Responses for this IC	97,500	0	97,500
Annual IC Time Burden (Hours)	16,575	-7,800	24,375
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Crosswalk - Prescription Drug Plan Survey	MA-PD_survey_crosswalk_2017.docx	07/17/2017

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