QIC Demonstration Evaluation Contractor (QDEC): Web Based Surveys

QIC Demonstration Evaluation Contractor (QDEC): Analyze Medicare Appeals to Conduct Formal Discussions and Reopenings with Suppliers

OMB: 0938-1348

IC ID: 227305

Information Collection (IC) Details

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QIC Demonstration Evaluation Contractor (QDEC): Web Based Surveys
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10633 Web Based Surveys QDEC_Attachment A Web Based Survey_Revised for Passback.docx Yes Yes Fillable Fileable

Health Health Care Services

 

2,540 1,524
   
Private Sector Businesses or other for-profits
 
   100 %

  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 2,540 0 2,540 0 0 0
Annual IC Time Burden (Hours) 423 0 423 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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