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Federal forms, ICRs, and supporting documents

Information Collection

MA-PD/PDP CAHPS Field Test Survey

IC 251371 under ICR 202201-0938-021 · OMB 0938-1432.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

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MA-PD/PDP CAHPS Field Test Survey
 
No New
 
Voluntary
 
42 CFR Part 423 Section 156 42 CFR Part 422 Section 152 42 CFR Part 417 Section 472  (To search for a specific CFR, visit the Code of Federal Regulations.)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10793 2022 Medicare Advantage Plan Survey Field Test Version 2022 MA-PD Field Test Survey_1-26-22.pdf Yes Yes Fillable Printable
Form and Instruction CMS-10793 2022 Prescription Drug Plan Survey 2022 PDP Field Test Survey_1-26-22.pdf Yes Yes Fillable Printable

Health Health Care Services

Health Plan Management System (HPMS)  83 FR 6591

1,000 0
   
Individuals or Households
 
   10 %

  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 1,000 0 0 1,000 0 0
Annual IC Time Burden (Hours) 170 0 0 170 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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