Information Collection

CMS-10549 Gen IC # 1 Testing Revisions to Advance Mailing Materials for the Medicare Current Beneficiary Survey

IC 245071 under ICR 202012-0938-015 · OMB 0938-1275.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1275 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
New FAQ text.docx	Instruction
New FAQ text.docx	Instruction
Revised Brochure.docx	Instruction
Revised Brochure.docx	Instruction
CMS-10549 Advance Letter Report AdvLtrReportFinal.pdf	Form and Instruction
CMS-10549 Advance Letter Report AdvLtrReportFinal.pdf	Form and Instruction
GenIC 1 Request to Test Advance Mail Materials.docx Mini Supporting Statement	IC Document
GenIC 1 Request to Test Advance Mail Materials.docx Mini Supporting Statement	IC Document

IC Title:

CMS-10549 Gen IC # 1 Testing Revisions to Advance Mailing Materials for the Medicare Current Beneficiary Survey

Agency IC Tracking Number:

ODEA

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			New FAQ text.docx	Yes	No	Printable Only
Instruction			Revised Brochure.docx	Yes	No	Printable Only
Form and Instruction	CMS-10549	Advance Letter Report	AdvLtrReportFinal.pdf	Yes	No	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 12,000

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	12,000	12,000
Annual IC Time Burden (Hours)	1	1
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Mini Supporting Statement	GenIC 1 Request to Test Advance Mail Materials.docx	12/22/2020

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