Information Collection

Medicaregov Medicare Plan Finder Survey

IC 257102 under ICR 202211-0938-011 · OMB 0938-1185.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10415 Medicaregov Medicare Plan Finder Survey	Form and Instruction
CMS-10415 Medicare.gov - Medicare Plan Finder Survey CMS-10415. Fast Track Medicaregov - Medicare Plan Finder Survey.docx	Form and Instruction
CMS-10415 Medicare.gov - Medicare Plan Finder Survey CMS-10415. Fast Track Medicaregov - Medicare Plan Finder Survey.docx	Form and Instruction
CMS-10415.Medicaregov Medicare Plan Finder Survey - Clearance Template.docx CMS-10415.Medicaregov Medicare Plan Finder Survey - Clearance Template	IC Document
CMS-10415.Medicaregov Medicare Plan Finder Survey - Clearance Template.docx CMS-10415.Medicaregov Medicare Plan Finder Survey - Clearance Template	IC Document

IC Title:

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-10415	Medicare.gov - Medicare Plan Finder Survey	CMS-10415. Fast Track Medicaregov - Medicare Plan Finder Survey.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 25,000

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	25,000	25,000
Annual IC Time Burden (Hours)	833	833
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
CMS-10415.Medicaregov Medicare Plan Finder Survey - Clearance Template	CMS-10415.Medicaregov Medicare Plan Finder Survey - Clearance Template.docx	11/25/2022

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