Information Collection

Medicare Administrative Contractor (MAC) Customer Experience (MCE) Program – Provider Contact Center - Palmetto Web Chat Library of Questions (CMS-10813)

IC 257140 under ICR 202211-0938-011 · OMB 0938-1185.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10813 Medicare Administrative Contractor (MAC) Customer Experience (MCE) Program – Provider Contact Center - Palmetto Web Chat Library of Questions (CMS-10813)	Form
CMS-10813 Web Chat Survey CMS-10813.Final Chat Survey.docx	Form
CMS-10813 Web Chat Survey CMS-10813.Final Chat Survey.docx	Form
CMS-10813. Palmetto Web Chat Fast Track Form.docx CMS-10813. Palmetto Web Chat Fast Track Form	IC Document
CMS-10813. Palmetto Web Chat Fast Track Form.docx CMS-10813. Palmetto Web Chat Fast Track Form	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Medicare Administrative Contractor (MAC) Customer Experience (MCE) Program â Provider Contact Center - Palmetto Web Chat Library of Questions (CMS-10813)

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	CMS-10813	Web Chat Survey	CMS-10813.Final Chat Survey.docx		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: 1,560

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,560	1,560
Annual IC Time Burden (Hours)	52	52
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
CMS-10813. Palmetto Web Chat Fast Track Form	CMS-10813. Palmetto Web Chat Fast Track Form.docx	11/28/2022

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