Information Collection

Patient Subject Matter Expert (PSME) Satisfaction Survey (CMS-10859)

IC 260502 under ICR 202211-0938-011 · OMB 0938-1185.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10859 PSME Satisfaction Survey Patient Subject Matter Expert (PSME) Satisfaction Survey (CMS-10859)	Form and Instruction
CMS-10859 PSME Satisfaction Survey CMS-10859 PSME Satisfaction survey.docx	Form and Instruction
CMS-10859 PSME Satisfaction Survey_Generic_Clearance_Submission(v1).docx CMS-10859 Supporting Statement	IC Document

IC Title:

Agency IC Tracking Number:

CCSQ

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 and Instruction	CMS-10859				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 198,698

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
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	198,698	198,698
Annual IC Time Burden (Hours)	6,557	6,557
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
CMS-10859 Supporting Statement		06/02/2023

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

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