Information Collection

CMS-10549.GenIC #5: MCBS Testing Revisions to Advance Mailing Materials

IC 239378 under ICR 201801-0938-008 · OMB 0938-1275.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1275 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
MCBS Current Brochure.pdf	Instruction
MCBS New FAQ text.docx	Instruction
MCBS Revised Brochure text only.docx	Instruction
CMS-10549.GenIC#5 - Mini Supporting Statement.docx Mini Supporting Statement	IC Document

IC Title:

CMS-10549.GenIC #5: MCBS Testing Revisions to Advance Mailing Materials

Agency IC Tracking Number:

OEDA

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Electronic Capability
Instruction	MCBS Current Brochure.pdf	No	Paper Only
Instruction	MCBS New FAQ text.docx	No	Paper Only
Instruction	MCBS Revised Brochure text only.docx	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 12,000

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	12,000	12,000
Annual IC Time Burden (Hours)	0	0
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Mini Supporting Statement	CMS-10549.GenIC#5 - Mini Supporting Statement.docx	01/22/2020

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