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CMS-10549 Gen IC # 1 Testing Revisions to Advance Mailing Materials for the Medicare Current Beneficiary Survey
Generic Clearance for Questionnaire Testing and Methodological Research for the Medicare Current Beneficiary Survey (MCBS) (CMS-10549)
OMB: 0938-1275
IC ID: 245071
OMB.report
HHS/CMS
OMB 0938-1275
ICR 202012-0938-015
IC 245071
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1275 can be found here:
2024-04-08 - Revision of a currently approved collection
Documents and Forms
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
Information Collection (IC) Details
View Information Collection (IC)
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:
Document Type
Form No.
Form Name
Instrument File
URL
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
Federal Enterprise Architecture Business Reference Module
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 %
Requested
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
12,000
0
12,000
0
0
0
Annual IC Time Burden (Hours)
1
0
1
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
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.