Information Collection

GenIC#16 Qualitative Testing of Creative Materials for Medicare

IC 230129 under ICR 201708-0938-025 · OMB 0938-1247.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1247 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10437.GenIC#16 GenIC#16 Qualitative Testing of Creative Materials for Medicare	Form and Instruction
CMS-10437.GenIC#16 GenIC#16 - MedicareCreativeTesting_FGguide_FINAL.docx CMS-10437.GenIC#16 - MedicareCreativeTesting_FGguide_FINAL.docx	Form and Instruction
CMS-10437.GenIC#16 - Justification for Providing Incentives for Participation in Marketing Research-revised-1-30-18 (final).docx GenIC#16 - Justification for Providing Incentives for Participation in Marketing Research	IC Document
CMS-10437.GenIC#16 - MedicareCreativeTesting_SupportingStatement_revised 1-30-18 (final).docx GenIC#16 - MedicareCreativeTesting_SupportingStatement	IC Document
CMS-10437.GenIC#16 - QualTestingCreativeMats_CoverPage_FINAL.docx CMS-10437.GenIC#16 - QualTestingCreativeMats_CoverPage	IC Document

IC Title:

GenIC#16 Qualitative Testing of Creative Materials for Medicare

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10437.GenIC#16	GenIC#16 - MedicareCreativeTesting_FGguide_FINAL.docx	CMS-10437.GenIC#16 - MedicareCreativeTesting_FGguide_FINAL.docx		Yes	No	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,000	1,000
Annual IC Time Burden (Hours)	1,500	1,500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
GenIC#16 - Justification for Providing Incentives for Participation in Marketing Research	CMS-10437.GenIC#16 - Justification for Providing Incentives for Participation in Marketing Research-revised-1-30-18 (final).docx	02/15/2018
GenIC#16 - MedicareCreativeTesting_SupportingStatement	CMS-10437.GenIC#16 - MedicareCreativeTesting_SupportingStatement_revised 1-30-18 (final).docx	02/15/2018
CMS-10437.GenIC#16 - QualTestingCreativeMats_CoverPage	CMS-10437.GenIC#16 - QualTestingCreativeMats_CoverPage_FINAL.docx	02/15/2018

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