MACBIS Software Application Electronic Surveys for Users (CMS-10719)

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

OMB: 0938-1185

IC ID: 257106

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MACBIS Software Application Electronic Surveys for Users (CMS-10719)
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-10719 MACBIS Software Application Electronic Surveys for Users Instrument_MACBIS Software Application Electronic Surveys for Users (version 3) CLEAN.docx Yes Yes Fillable Fileable

Health Health Care Services

 

2,081 0
   
State, Local, and Tribal Governments
 
   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 2,081 0 2,081 0 0 0
Annual IC Time Burden (Hours) 173 0 173 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
CMS-10719 - Fast Track Supporting Statement (version 3) CMS-10719 - Fast Track Supporting Statement (version 3).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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