Information Collection

Internet Quality Improvement and Evaluation System (IQIES) Idea Portal

IC 254129 under ICR 202009-0938-002 · OMB 0938-1397.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1397 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10810 Idea Portal Internet Quality Improvement and Evaluation System (IQIES) Idea Portal	Form and Instruction
CMS-10810 Idea Portal CMS-10810- Idea portal screen shot.pdf	Form and Instruction
CMS-10810 iQIES Idea Portal - ICR.docx IQIES Idea Portal supporting statement	IC Document

IC Title:

Internet Quality Improvement and Evaluation System (IQIES) Idea Portal

Agency IC Tracking Number:

CCSQ

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-10810				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,000

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

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	1,000	1,000
Annual IC Time Burden (Hours)	83	83
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
IQIES Idea Portal supporting statement		06/08/2022

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

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