OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

COVID-19 Campaign Survey on Fee-for-Service CMS.gov (CMS-10766)

IC 257122 under ICR 202211-0938-011 · OMB 0938-1185.

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)

COVID-19 Campaign Survey on Fee-for-Service CMS.gov (CMS-10766)
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10766 CMS-10766.Instrument for COVID-19 Campaign Page Feedback Survey CMS-10766.Instrument for COVID-19 Campaign Page Feedback Survey.docx Yes Yes Fillable Fileable

Health Health Care Services

 

4,872 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 4,872 0 4,872 0 0 0
Annual IC Time Burden (Hours) 81 0 81 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
CMS-10766.COVID_19 Campaign Survey Fast Track Request CMS-10766.COVID_19 Campaign Survey Fast Track.docx 11/25/2022
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.