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

Testing of Web Survey Design and Administration for CMS Experience of Care Surveys (CMS-10694)

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

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.