CMS-10731.(GenIC#2) - CBR Feedback Survey

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

Documents and Forms

Document Name Document Type
Form CMS-10731. (GenIC# CMS-10731.(GenIC#2) - CBR Feedback Survey Form and Instruction
CMS-10731. (GenIC# CMS-10731. (GenIC#2) CBR Feedback Survey CMS-10731. (GenIC#2) CBR Feedback Survey.docx Form and Instruction
CMS-10731. (GenIC#2) Fast Track Submission Request for CBR Feedback Survey .docx CMS-10731. (GenIC#2) Fast Track Submission Request for CBR Feedback Survey IC Document

Information Collection (IC) Details

IC Title:	CMS-10731.(GenIC#2) - CBR Feedback Survey	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 and Instruction	CMS-10731. (GenIC#2)	CMS-10731. (GenIC#2) CBR Feedback Survey	CMS-10731. (GenIC#2) CBR Feedback Survey.docx		Yes	Yes	Fillable Fileable

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, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	25	25
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
CMS-10731. (GenIC#2) Fast Track Submission Request for CBR Feedback Survey	CMS-10731. (GenIC#2) Fast Track Submission Request for CBR Feedback Survey .docx	11/04/2024

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