Information Collection

GenIC #17 Formative Research and Materials Testing for Medicare

IC 244549 under ICR 202011-0938-009 · OMB 0938-1247.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

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-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 %

table that charts list of burden
	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

table that charts IC Documents
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.