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

Documents and forms in this information collection
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

IC Title:

Agency IC Tracking Number:

CM-CPC

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-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 %

table that charts list of burden
	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

table that charts IC Documents
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.