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MACBIS Software Application Electronic Surveys for Users - Webinar Survey Polling Questions (CMS-10719)
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (CMS-10415)
OMB: 0938-1185
IC ID: 257123
OMB.report
HHS/CMS
OMB 0938-1185
ICR 202211-0938-011
IC 257123
( )
Documents and Forms
Document Name
Document Type
Form CMS-10719
MACBIS Software Application Electronic Surveys for Users - Webinar Survey Polling Questions (CMS-10719)
Form
CMS-10719 MACBIS Software Application Electronic Survey
Webinar Survey_Polling Questions.xlsx
Form
CMS-10719 MACBIS Software Application Electronic Survey
Webinar Survey_Polling Questions.xlsx
Form
CMS-10719 - Fast Track Supporting Statement - Nov 2020 udpate v2 CLEAN.docx
CMS-10719 - Fast Track Supporting Statement - Nov 2020 udpate v2 CLEAN
IC Document
CMS-10719 - Fast Track Supporting Statement - Nov 2020 udpate v2 CLEAN.docx
CMS-10719 - Fast Track Supporting Statement - Nov 2020 udpate v2 CLEAN
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
MACBIS Software Application Electronic Surveys for Users - Webinar Survey Polling Questions (CMS-10719)
Agency IC Tracking Number:
IC Status:
New
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
CMS-10719
MACBIS Software Application Electronic Survey
Webinar Survey_Polling Questions.xlsx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
2,775
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
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
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
Documents for IC
Title
Document
Date Uploaded
CMS-10719 - Fast Track Supporting Statement - Nov 2020 udpate v2 CLEAN
CMS-10719 - Fast Track Supporting Statement - Nov 2020 udpate v2 CLEAN.docx
11/25/2022
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.