GenIC #17 Formative Research and Materials Testing for Medicare

Generic Social Marketing & Consumer Testing Research (CMS-10437)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1247 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10437.GenIC#17 GenIC #17 Formative Research and Materials Testing for Medicare Form and Instruction
CMS-10437.GenIC#17 CMS-10437.GenIC#17 - FormativeandMatsMedicare_FGGuide_FI CMS-10437.GenIC#17 - FormativeandMatsMedicare_FGGuide_FINAL.docx Form and Instruction
CMS-10437.GenIC#17 - Justification for Providing Incentives for Participation in Marketing Research (final).docx CMS-10437.GenIC#17 - Justification for Providing Incentives for Participation in Marketing Research (final) IC Document
CMS-10437.GenIC#17 - MedicareFormativeMatsTesting_CoverPage_FINAL.docx CMS-10437.GenIC#17 - MedicareFormativeMatsTesting_CoverPage_FINAL IC Document
CMS-10437.GenIC#17 - MedicareFormativeMatsTesting_Supporting Statement_REVISED 1-30-18 (final).docx CMS-10437.GenIC#17 - MedicareFormativeMatsTesting_Supporting Statement_REVISED 1-30-18 (final) IC Document

Information Collection (IC) Details

IC Title:	GenIC #17 Formative Research and Materials Testing for Medicare	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10437.GenIC#17	CMS-10437.GenIC#17 - FormativeandMatsMedicare_FGGuide_FINAL	CMS-10437.GenIC#17 - FormativeandMatsMedicare_FGGuide_FINAL.docx		Yes	No	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 600	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	600	600
Annual IC Time Burden (Hours)	900	900
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
CMS-10437.GenIC#17 - Justification for Providing Incentives for Participation in Marketing Research (final)	CMS-10437.GenIC#17 - Justification for Providing Incentives for Participation in Marketing Research (final).docx	11/19/2020
CMS-10437.GenIC#17 - MedicareFormativeMatsTesting_CoverPage_FINAL	CMS-10437.GenIC#17 - MedicareFormativeMatsTesting_CoverPage_FINAL.docx	11/19/2020
CMS-10437.GenIC#17 - MedicareFormativeMatsTesting_Supporting Statement_REVISED 1-30-18 (final)	CMS-10437.GenIC#17 - MedicareFormativeMatsTesting_Supporting Statement_REVISED 1-30-18 (final).docx	11/19/2020

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