GenIC #20 Medicare Online Qualitative Panel Monthly Survey

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⚠️ Notice: This information collection may be referencing outdated material.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#20 GenIC #20 Medicare Online Qualitative Panel Monthly Survey Form and Instruction
CMS-10437.GenIC#20 CMS-10437.GenIC#20 -Qualitative Panel Survey (final).doc CMS-10437.GenIC#20 -Qualitative Panel Survey (final).docx Form and Instruction
CMS-10437.GenIC#20 - Medicare Online Qualitative Panel Monthly Survey Supporting Statement (final 8-4-20).docx CMS-10437.GenIC#20 - Medicare Online Qualitative Panel Monthly Survey Supporting Statement (final 8-4-20) IC Document
CMS-10437.GenIC#20 - Medicare Online Panel CoverPage (final).docx CMS-10437.GenIC#20 - Medicare Online Panel CoverPage (final).docx IC Document

Information Collection (IC) Details

IC Title:	GenIC #20 Medicare Online Qualitative Panel Monthly Survey	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#20	CMS-10437.GenIC#20 -Qualitative Panel Survey (final).docx	CMS-10437.GenIC#20 -Qualitative Panel Survey (final).docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 500	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	6,000	6,000
Annual IC Time Burden (Hours)	500	500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
CMS-10437.GenIC#20 - Medicare Online Qualitative Panel Monthly Survey Supporting Statement (final 8-4-20)	CMS-10437.GenIC#20 - Medicare Online Qualitative Panel Monthly Survey Supporting Statement (final 8-4-20).docx	11/19/2020
CMS-10437.GenIC#20 - Medicare Online Panel CoverPage (final).docx	CMS-10437.GenIC#20 - Medicare Online Panel CoverPage (final).docx	11/19/2020

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