Information Collection Request

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

ICR 201707-0938-017 · 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 Modified Repair queued
CMS-10488 - 2018 QHP Survey_Part B.docx Supporting Statement B Uploaded 2017-07-28 Available
CMS-10488 - 2018 QHP Survey_SSA 2017.docx Supporting Statement A Uploaded 2017-07-28 Available

IC Document Collections

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

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
09/30/2020 36 Months From Approved 09/30/2017
90,015 0 105,015
22,523 0 37,823
0 0 0





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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, 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 1 (English) ,   QHP Survey (Spanish) ,   Cover Letter (Spanish) ,   Chinese Cover Letter - 2 ,   Chinese Prenotification Letter ,   Chinese Reminder Letter ,   English Cover Letter 2 ,   English Cover Letter 2

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 90,015 105,015 0 0 -15,000 0
Annual Time Burden (Hours) 22,523 37,823 0 0 -15,300 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


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