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 Survey of MA and Part D Medicare Compliance Officers on Availability of Email Address 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				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		03/10/2021
Email invitations for Survey of Plan Staff		03/10/2021

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

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].