Information Collection Request

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

ICR 202009-0938-018 · OMB 0938-1221 · 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
2021 QHP Survey_Part A Final-.docx Supporting Statement A Uploaded 2020-09-30 Available
2021 QHP Survey_Part B.docx Supporting Statement B Uploaded 2020-09-30 Available
2021 QHP Enrollee Survey Public Comments Responses.docx Supplementary Document Uploaded 2020-09-30 Repair queued
2021 QHP Enrollee Survey Change Crosswalk.docx Supplementary Document Uploaded 2020-09-30 Repair queued

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
11/30/2023 36 Months From Approved 11/30/2020
82,500 0 90,015
49,550 0 57,230
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 Survey Vendor Application ,   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 ,   Chinese Reminder Letter ,   English Cover Letter 2 ,   English Cover Letter 2

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 82,500 90,015 0 0 -7,515 0
Annual Time Burden (Hours) 49,550 57,230 0 0 -7,680 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


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