Information Collection

Medicare Administrative Contractor (MAC) Customer Experience (MCE) Program – Provider Contact Center - Written Correspondence Survey (CMS-10814)

IC 257141 under ICR 202211-0938-011 · OMB 0938-1185.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10814 Medicare Administrative Contractor (MAC) Customer Experience (MCE) Program – Provider Contact Center - Written Correspondence Survey (CMS-10814)	Form
CMS-10814 CMS-10814. Written Correspondence Instrument CMS-10814. Written Correspondence Instrument.docx	Form
CMS-10814 CMS-10814. Written Correspondence Instrument CMS-10814. Written Correspondence Instrument.docx	Form
CMS-10814. Link for PRA Disclosure Statement.pdf CMS-10814. Link for PRA Disclosure Statement	IC Document
CMS-10814. Link for PRA Disclosure Statement.pdf CMS-10814. Link for PRA Disclosure Statement	IC Document

IC Title:

Medicare Administrative Contractor (MAC) Customer Experience (MCE) Program â Provider Contact Center - Written Correspondence Survey (CMS-10814)

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-10814	CMS-10814. Written Correspondence Instrument	CMS-10814. Written Correspondence Instrument.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: 09-90-1901 HHS Correspondence, Customer Service, and Contact List Records,

FR Citation: 84 FR 28823

Number of Respondents: 10,000

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

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

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	10,000	10,000
Annual IC Time Burden (Hours)	500	500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
CMS-10814. Link for PRA Disclosure Statement	CMS-10814. Link for PRA Disclosure Statement.pdf	11/28/2022

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