Information Collection

GenIC #3 MA and PDP CAHPS Web Survey of Health and Drug Plans

IC 246172 under ICR 201904-0938-010 · OMB 0938-1370.

Documents and Forms

Document Name Document Type
Form CMS-10694 GenIC #3 MA and PDP CAHPS Web Survey of Health and Drug Plans Form and Instruction
CMS-10694 Survey of MA and Part D Medicare Compliance Officers on Survey of Plan Staff_.docx Form and Instruction
GenIC#3 Generic Supporting Statement_MCO_survey.docx Generic Supporting Statement IC Document
Email invitations for Survey of Plan Staff.docx Email invitations for Survey of Plan Staff IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	GenIC #3 MA and PDP CAHPS Web Survey of Health and Drug Plans	Agency IC Tracking Number:	CM-CPC

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-10694	Survey of MA and Part D Medicare Compliance Officers on Availability of Email Address	Survey of Plan Staff_.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 183	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	183	183
Annual IC Time Burden (Hours)	6	6
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Generic Supporting Statement	GenIC#3 Generic Supporting Statement_MCO_survey.docx	03/10/2021
Email invitations for Survey of Plan Staff	Email invitations for Survey of Plan Staff.docx	03/10/2021

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