Production - Plan Finder
Q1 What is your feedback about?
Information on this page (1)
A technical issue (2)
Something else (3)
Display This Question:
If “What is your feedback about? - Information on this page” is selected
Q2
How can we make this page better? Please be as specific as possible.
Please do not include any personal health or login information.
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Display This Question:
If “What is your feedback about? - A technical issue” is selected
Q3
Please describe the technical issue as specifically as possible.
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Display This Question:
If “What is your feedback about? - Something else” is selected
Q4 Please provide your feedback, being as specific as possible. Please do not include any personal health or login information.
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Q5 What was the purpose of this visit?
View Plan Benefits (101)
Compare and Enroll in a plan (102)
View Drug Pricing (103)
Something Else (104)
Display This Question:
If “What was the purpose of this visit? - Something Else” is selected
Q6 Please describe the purpose of this visit. Please do not include any personal information.
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Q7 Please rate the ease of each of the following tasks.
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Very Difficult (1) |
Difficult (2) |
Neither Difficult or Easy (3) |
Easy (4) |
Very Easy (5) |
Knowing where to navigate to find what you're looking for on Medicare Plan Finder is (select one option to the right) (1) |
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Understanding the information on Medicare Plan Finder is (select one option to the right) (2) |
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Finding the information you were looking for on Medicare Plan Finder is (select one option to the right) (3) |
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Q8 How satisfied are you with your visit today?
Very satisfied (1)
Somewhat satisfied (2)
Neither satisfied nor dissatisfied (3)
Somewhat dissatisfied (4)
Very dissatisfied (5)
PRA Disclosure Statement
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-XXXX. The expiration date is (XX/XX/XXXX). The time required to complete this information collection is estimated to average [Insert Time (hours or minutes)] per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850. ****CMS Disclosure**** Please do not send applications, claims, payments, medical records or any documents containing sensitive information to the PRA Reports Clearance Office. Please note that any correspondence not pertaining to the information collection burden approved under the associated OMB control number listed on this form will not be reviewed, forwarded, or retained. If you have questions or concerns regarding where to submit your documents, please contact [List Program Specific Contact].
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |