Information Collection

CMS-10437.GenIC#28 - Marketplace and Medicare Health Insurance Literacy Survey

IC 265762 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⚠️ Notice: This information collection may be referencing outdated material.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#28 Marketplace and Medicare Health Insurance Literacy Survey CMS-10437.GenIC#28 - Marketplace and Medicare Health Insurance Literacy Survey	Form and Instruction
CMS-10437.GenIC#28 Marketplace and Medicare Health Insurance Literacy Surve CMS-10437#28.Survey Instrument - final.docx	Form and Instruction
CMS-10437#28.Cover Sheet - final.docx CMS-10437#28.Cover Sheet - final	IC Document
CMS-10437.GenIC#28.Supporting Statement - final.docx CMS-10437.GenIC#28.Supporting Statement - final	IC Document

IC Title:

CMS-10437.GenIC#28 - Marketplace and Medicare Health Insurance Literacy 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#28				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,400

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,400	2,400
Annual IC Time Burden (Hours)	600	600
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
CMS-10437#28.Cover Sheet - final		03/04/2024
CMS-10437.GenIC#28.Supporting Statement - final		03/04/2024

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

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