Information Collection Request

Health Insurance Marketplace Consumer Experience Surveys: Enrollee Satisfaction Survey and Marketplace Survey Data Collection (CMS-10488)

ICR 202005-0938-010 · OMB 0938-1221 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10488 Adult Qualified Health Plan Enrollee Experience Survey Form and Instruction Modified Available
CMS-10488-Supporting Statement QHP Survey Final x.docx Supporting Statement A Uploaded 2020-09-03 Available
CMS-10488 2020 NonSubtantive Change Request - COVID19 MQI - 05-2020.docx Justification for No Material/Nonsubstantive Change Uploaded 2020-05-21 Available
CMS-10488 - QHP Survey_Part B.docx Supporting Statement B Uploaded 2020-05-21 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
210330 Adult Qualified Health Plan Enrollee Experience Survey Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
09/30/2020 09/30/2020 09/30/2020
90,015 0 90,015
57,230 0 22,523
0 0 0





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table that charts list of burden
IC Title Form No. Form Name
Adult Qualified Health Plan Enrollee Experience Survey CMS-10488 , CMS-10488, CMS-10488, CMS-10488, CMS-10488, CMS-10488, CMS-10488, CMS-10488, CMS-10488, CMS-10488, CMS-10488, CMS-10488 2017 QHP Survey (Chinese) ,   Cover Letter (Chinese) ,   QHP Survey (English) ,   Cover Letter 1 (English) ,   QHP Survey (Spanish) ,   Cover Letter (Spanish) ,   Chinese Cover Letter - 2 ,   Chinese Prenotification Letter ,   English Cover Letter 2 ,   Chinese Reminder Letter ,   English Cover Letter 2 ,   Survey Vendor Application

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 90,015 90,015 0 0 0 0
Annual Time Burden (Hours) 57,230 22,523 0 0 34,707 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


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