Information Collection Request

Generic Clearance for CMS and Medicare Administrative Contractor (MAC)Generic Customer Experience (CMS-10731)

ICR 202304-0938-022 · OMB 0938-1459 · Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10961 Electronic Prior Auth Survey Form and Instruction New Repair queued
Form CMS-10815 CMS-10815. Call Center Question List Form New Repair queued
Form CMS-10814 CMS-10814. Written Correspondence Instrument Form and Instruction New Repair queued
Form CMS-10812 CMS-10812. Audit and Reimbursement - Website Form and Instruction New Repair queued
Form CMS-10812 CMS-10812. Audit and Reimbursement - Letter Form and Instruction New Repair queued
Form CMS-10763 CMS-10763.Medical Review Survey - English final Form and Instruction New Repair queued
Form CMS-10763 CMS-10763.Medical Review Survey - Spanish final Form and Instruction New Repair queued
Form CMS-10760 CMS-10760.Flu Campaign Page Feedback Survey Form and Instruction New Repair queued
Form CMS-10721 CMS-10721.Final Persistent Website Feedback Survey Form and Instruction New Repair queued
Form CMS-10721 CMS-10721.Final Persistent Website Feedback Survey (Spanish) Form and Instruction New Repair queued
Form CMS-10721 CMS-10721.Final Persistent Portal Feedback Survey Form and Instruction New Repair queued
Form CMS-10721 CMS-10721.Final Persistent Portal Feedback Survey (Spanish) Form and Instruction New Repair queued
Form CMS-10720 CMS-10720.Final Overall Portal Feedback Survey (Spanish) Form and Instruction New Repair queued
Form CMS-10720 CMS-10720.Final Overall Website Feedback Survey (Spanish) Form and Instruction New Repair queued
Form CMS-10720 CMS-10720.Final Overall Portal Feedback Survey Form and Instruction New Repair queued
Form CMS-10720 CMS-10720.Final Overall Website Feedback Survey Form and Instruction New Repair queued
Form CMS-10731.(GenIC#8 CMS-10731.(GenIC#8) WISeR Survey Instrument Form and Instruction New Repair queued
Form CMS-10941 Measuring Provider Trust in Medicare Form and Instruction New Repair queued
Form CMS-10731.GenIC#6 CMS-10731.GenIC#6 - Provider_Type_UX_Study_Homework_Template_for_OMB Form and Instruction New Repair queued
Form CMS-10731.GenIC#6 CMS-10731.GenIC#6 - Provider_Type_UX_Study_Moderators_Guide_for_OMB Form and Instruction New Repair queued
Form CMS-10731.GenIc#5 Palmetto Web Chat Survey Library Form and Instruction New Repair queued
Form CMS-10731.GenIC#4 Medicare_Learning_Network_Provider_Association_Partnership Survey Form and Instruction New Repair queued
Form CMS-10731. (GenIC# CMS-10731 (GenIC#1). Was This Page Helfpul Survey Form and Instruction New Available
Form CMS-10731. (GenIC# CMS-10731. (GenIC#2) CBR Feedback Survey Form and Instruction New Available
CMS-10731_Supporting_Statement_Part_A (30-day).docx Supporting Statement A Uploaded 2023-04-27 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
280107 Electronic Prior Authorization Feedback (CMS-10961) Form and Instruction NewElectronic Prior Auth Survey
279794 Medicare Administrative Contractor (MAC) Customer Experience (MCE) Program – Provider Contact Center - Telephone Library of Questions (CMS-10815) Form NewCMS-10815. Call Center Question List
279744 Medicare Administrative Contractor (MAC) Customer Experience (MCE) Program – Provider Contact Center - Written Correspondence Survey (CMS-10814) Form and Instruction NewCMS-10814. Written Correspondence Instrument
279743 Medicare Administrative Contractor (MAC) Customer Experience (MCE) Program – Audit and Reimbursement (CMS-10812) Form and Instruction NewCMS-10812. Audit and Reimbursement - Website
279743 Medicare Administrative Contractor (MAC) Customer Experience (MCE) Program – Audit and Reimbursement (CMS-10812) Form and Instruction NewCMS-10812. Audit and Reimbursement - Letter
279742 Medicare Administrative Contactors Customer Experience – Medical Review (CMS-10763) Form and Instruction NewCMS-10763.Medical Review Survey - English final
279742 Medicare Administrative Contactors Customer Experience – Medical Review (CMS-10763) Form and Instruction NewCMS-10763.Medical Review Survey - Spanish final
279741 Overall Flu Campaign Feedback Survey (CMS-10760) Form and Instruction NewCMS-10760.Flu Campaign Page Feedback Survey
279740 Medicare Administrative Contractor (MAC) Provider Experience Persistent Feedback (CMS-10721) Form and Instruction NewCMS-10721.Final Persistent Website Feedback Survey
279740 Medicare Administrative Contractor (MAC) Provider Experience Persistent Feedback (CMS-10721) Form and Instruction NewCMS-10721.Final Persistent Website Feedback Survey (Spanish)
279740 Medicare Administrative Contractor (MAC) Provider Experience Persistent Feedback (CMS-10721) Form and Instruction NewCMS-10721.Final Persistent Portal Feedback Survey
279740 Medicare Administrative Contractor (MAC) Provider Experience Persistent Feedback (CMS-10721) Form and Instruction NewCMS-10721.Final Persistent Portal Feedback Survey (Spanish)
279736 Medicare Administrative Contractor (MAC) Provider Customer Experience (CMS-10720) Form and Instruction NewCMS-10720.Final Overall Portal Feedback Survey (Spanish)
279736 Medicare Administrative Contractor (MAC) Provider Customer Experience (CMS-10720) Form and Instruction NewCMS-10720.Final Overall Website Feedback Survey (Spanish)
279736 Medicare Administrative Contractor (MAC) Provider Customer Experience (CMS-10720) Form and Instruction NewCMS-10720.Final Overall Portal Feedback Survey
279736 Medicare Administrative Contractor (MAC) Provider Customer Experience (CMS-10720) Form and Instruction NewCMS-10720.Final Overall Website Feedback Survey
279275 CMS-10731.(GenIC#8) - Centers Medicare & Medicaid Services Wasteful and Inappropriate Service Reduction (WISeR) Model Feedback Form and Instruction NewCMS-10731.(GenIC#8) WISeR Survey Instrument
277604 CMS-10941.Medicare Provider Trust Feedback Survey Form and Instruction NewMeasuring Provider Trust in Medicare
273762 CMS-10731.GenIC#6 - Provider Type UX Study Form and Instruction NewCMS-10731.GenIC#6 - Provider_Type_UX_Study_Homework_Template_for_OMB
273762 CMS-10731.GenIC#6 - Provider Type UX Study Form and Instruction NewCMS-10731.GenIC#6 - Provider_Type_UX_Study_Moderators_Guide_for_OMB
273761 CMS-10731.GenIC#5 - Medicare Administrative Contractor (MAC) Customer Experience (MCE) Program – Provider Contact Center - Palmetto Web Chat Library of Questions Form and Instruction NewPalmetto Web Chat Survey Library
273760 CMS-10731.GenIC#4 - Medicare Learning Network Provider Association Partnership Survey Form and Instruction NewMedicare_Learning_Network_Provider_Association_Partnership Survey
272113 CMS-10731(GenIC#1). Was This Page Helpful Survey Form and Instruction NewCMS-10731 (GenIC#1). Was This Page Helfpul Survey
272112 CMS-10731.(GenIC#2) - CBR Feedback Survey Form and Instruction NewCMS-10731. (GenIC#2) CBR Feedback Survey

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
01/31/2027 36 Months From Approved
1,000,000 0 0
50,000 0 0
0 0 0





Reginfo record details
15
table that charts list of burden
IC Title Form No. Form Name
Medicare Administrative Contactors Customer Experience – Medical Review (CMS-10763) CMS-10763, CMS-10763 ,  
CMS-10731(GenIC#1). Was This Page Helpful Survey CMS-10731. (GenIC#1)
CMS-10731.(GenIC#2) - CBR Feedback Survey CMS-10731. (GenIC#2)
CMS-10731.(GenIC#8) - Centers Medicare & Medicaid Services Wasteful and Inappropriate Service Reduction (WISeR) Model Feedback CMS-10731.(GenIC#8)
CMS-10731.GenIC#4 - Medicare Learning Network Provider Association Partnership Survey CMS-10731.GenIC#4
CMS-10731.GenIC#5 - Medicare Administrative Contractor (MAC) Customer Experience (MCE) Program – Provider Contact Center - Palmetto Web Chat Library of Questions CMS-10731.GenIc#5
CMS-10731.GenIC#6 - Provider Type UX Study CMS-10731.GenIC#6, CMS-10731.GenIC#6 ,  
CMS-10941.Medicare Provider Trust Feedback Survey CMS-10941
Electronic Prior Authorization Feedback (CMS-10961) CMS-10961
Medicare Administrative Contractor (MAC) Customer Experience (MCE) Program – Audit and Reimbursement (CMS-10812) CMS-10812, CMS-10812 ,  
Medicare Administrative Contractor (MAC) Customer Experience (MCE) Program – Provider Contact Center - Telephone Library of Questions (CMS-10815) CMS-10815
Medicare Administrative Contractor (MAC) Customer Experience (MCE) Program – Provider Contact Center - Written Correspondence Survey (CMS-10814) CMS-10814
Medicare Administrative Contractor (MAC) Provider Customer Experience (CMS-10720) CMS-10720, CMS-10720, CMS-10720, CMS-10720 ,   ,   ,  
Medicare Administrative Contractor (MAC) Provider Experience Persistent Feedback (CMS-10721) CMS-10721, CMS-10721, CMS-10721, CMS-10721 ,   ,   ,  
Overall Flu Campaign Feedback Survey (CMS-10760) CMS-10760

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 1,000,000 0 0 1,000,000 0 0
Annual Time Burden (Hours) 50,000 0 0 50,000 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No