Account Manager Satisfaction Survey (CMS-10748)

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

Documents and Forms

Document Name Document Type
Form CMS-10748 Account Manager Satisfaction Survey (CMS-10748) Form
CMS-10748 Account Manager Survey 2- Survey Questionsrevised.docx Form
CMS-10748 Account Manager Survey 2- Survey Questionsrevised.docx Form
CMS-10748 - Fast Track Supporting Statement (2020 version 3) (1).docx CMS-10748 - Fast Track Supporting Statement (2020 version 3) IC Document
CMS-10748 - Fast Track Supporting Statement (2020 version 3) (1).docx CMS-10748 - Fast Track Supporting Statement (2020 version 3) IC Document

Information Collection (IC) Details

IC Title:	Account Manager Satisfaction Survey (CMS-10748)	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-10748	Account Manager Survey	2- Survey Questionsrevised.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 300	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	5	5
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
CMS-10748 - Fast Track Supporting Statement (2020 version 3)	CMS-10748 - Fast Track Supporting Statement (2020 version 3) (1).docx	11/25/2022

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