Information Collection

GenIC #20 Medicare Online Qualitative Panel Monthly Survey

IC 244550 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⚠️ Notice: This information collection may be referencing outdated material.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#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

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:

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#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 %

table that charts list of burden
	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

table that charts IC Documents
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.