Information Collection

Medicare Casework Customer Satisfaction Survey (CMS-10746)

IC 257113 under ICR 202211-0938-011 · OMB 0938-1185.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10746 Medicare Casework Customer Satisfaction Survey (CMS-10746)	Form and Instruction
CMS-10746 Script: Medicare Casework Customer Satisfaction Survey CMS-10746 - Survey Script.docx	Form and Instruction
CMS-10746 Script: Medicare Casework Customer Satisfaction Survey CMS-10746 - Survey Script.docx	Form and Instruction
CMS-10746 - Fast Track Supporting Statement (2020 version 3).docx CMS-10746 - Fast Track Supporting Statement (2020 version 3)	IC Document
CMS-10746 - Fast Track Supporting Statement (2020 version 3).docx CMS-10746 - Fast Track Supporting Statement (2020 version 3)	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-10746	Script: Medicare Casework Customer Satisfaction Survey	CMS-10746 - Survey Script.docx		No		Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5,000

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	5,000	5,000
Annual IC Time Burden (Hours)	167	167
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
CMS-10746 - Fast Track Supporting Statement (2020 version 3)	CMS-10746 - Fast Track Supporting Statement (2020 version 3).docx	11/25/2022

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