GenIC#18 - Medicare Advantage Regional Outreach Experiment Survey

Generic Social Marketing & Consumer Testing Research (CMS-10437)

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Form CMS-10437- GenIC#1 GenIC#18 - Medicare Advantage Regional Outreach Experiment Survey Form and Instruction
CMS-10437- GenIC#1 Medicare Advantage Regional Outreach Experiment Survey ( CMS-10437#18.Medicare Advantage Survey_OnlineVersion_101918.docx Form and Instruction
CMS-1037 GenIC#18 CMS-10437#18.Medicare Advantage Survey (Telephone Versio CMS-10437#18.Medicare Advantage Survey_TelephoneVersion_101918.docx Form and Instruction
CMS-10437#18.MAExperiment_SupportingStatement_FINAL - 11-26-18.docx CMS-10437#18.MAExperiment_SupportingStatement_FINAL - 11-26-18 IC Document
CMS-10437#18. MAExperiment_CoverPage_101918.docx CMS-10437#18. MAExperiment_CoverPage IC Document

Information Collection (IC) Details

IC Title:	GenIC#18 - Medicare Advantage Regional Outreach Experiment Survey	Agency IC Tracking Number:

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 and Instruction	CMS-10437- GenIC#18	Medicare Advantage Regional Outreach Experiment Survey (Online Version)	CMS-10437#18.Medicare Advantage Survey_OnlineVersion_101918.docx		Yes	Yes	Fillable Fileable
Form and Instruction	CMS-1037 GenIC#18	CMS-10437#18.Medicare Advantage Survey (Telephone Version)	CMS-10437#18.Medicare Advantage Survey_TelephoneVersion_101918.docx		Yes	No	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,600	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	1,600	1,600
Annual IC Time Burden (Hours)	267	267
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
CMS-10437#18.MAExperiment_SupportingStatement_FINAL - 11-26-18	CMS-10437#18.MAExperiment_SupportingStatement_FINAL - 11-26-18.docx	11/26/2018
CMS-10437#18. MAExperiment_CoverPage	CMS-10437#18. MAExperiment_CoverPage_101918.docx	11/26/2018

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