30724 Q_Medicaid.gov_updated by Michelle July 14 2020

E-Government Website Customer Satisfaction Surveys

OMB: 1090-0008

IC ID: 252231

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

View Information Collection (IC)

30724 Q_Medicaid.gov_updated by Michelle July 14 2020 30724 Q_Medicaid.gov_updated by Michelle July 14 2
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 30724 Q_Medicaid.gov_updated by Michelle July 14 2 30724 Q_Medicaid.gov_updated by Michelle July 14 2020 30724 Q_Medicaid.gov_updated by Michelle July 14 2020.xlsx Yes Yes Fillable Fileable

General Government Central Records & Statistical Mgt

 

1,382 0
   
Individuals or Households
 
   100 %

  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 1,382 0 0 0 0 1,382
Annual IC Time Burden (Hours) 174 0 0 0 0 174
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Foresee Survey Approval - 1090-0008 Generic Clearance Request Form CMS June 2020 with signature Foresee Survey Approval - 1090-0008 Generic Clearance Request Form CMS June 2020 with signature.pdf 03/17/2022
1090-0008 Survey Mapping Document CMS June 2020 1090-0008 Survey Mapping Document CMS June 2020.docx 03/17/2022
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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