Medicare.gov Sitewide Qualtrics Survey (CMS-10676)

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (CMS-10415)

OMB: 0938-1185

IC ID: 257103

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

View Information Collection (IC)

Medicare.gov Sitewide Qualtrics Survey (CMS-10676)
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10676 Medicare.gov Sitewide Qualtrics Survey CMS-10676.Medicare.gov Sitewide Qualtrics Survey.docx Yes Yes Fillable Fileable

Health Health Care Services

 

100,000 0
   
Individuals or Households
 
   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 100,000 0 100,000 0 0 0
Annual IC Time Burden (Hours) 8,333 0 8,333 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
CMS-10676.Generic Clearance Template (MedicareQualtrics) FINAL CMS-10676.Generic Clearance Template (MedicareQualtrics) FINAL (1).docx 11/25/2022
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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