Information Collection Request

Health Insurance Marketplace Consumer Experience Surveys: Enrollee Satisfaction Survey and Marketplace Survey Data Collection (CMS-10488)

ICR 202307-0938-006 · OMB 0938-1221 · Received in OIRA

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10488 Adult Qualified Health Plan Enrollee Experience Survey Form and Instruction Modified Repair queued
2024-QHP-EnrollSurvey-SSA-508.docx Supporting Statement A Uploaded 2023-07-31 Repair queued
2024-QHP-EnrollSurvey-SS-B-508.docx Supporting Statement B Uploaded 2023-07-13 Repair queued
2024-QHP-Enrollee-Survey-Change-Crosswalk.docx Supplementary Document Uploaded 2023-07-13 Repair queued
2024-Responses-to-Public-Comments-to-the-QHP-Enrollee-Survey-Final.docx Supplementary Document Uploaded 2023-07-13 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
210330 Adult Qualified Health Plan Enrollee Experience Survey Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Requested Previously Approved
36 Months From Approved 11/30/2023
97,505 105,010
48,872 54,050
0 0





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
Adult Qualified Health Plan Enrollee Experience Survey CMS-10488 , CMS-10488, CMS-10488, CMS-10488, CMS-10488, CMS-10488, CMS-10488, CMS-10488, CMS-10488, CMS-10488, CMS-10488, CMS-10488, CMS-10488, CMS-10488, CMS_10488 Survey Vendor Application ,   QHP Survey (Chinese) ,   Cover Letter (Chinese) ,   QHP Survey (English) ,   Cover Letter 1 (English) ,   QHP Survey (Spanish) ,   Cover Letter (Spanish) ,   Chinese Cover Letter - 2 ,   Chinese Prenotification Letter ,   Chinese Reminder Letter ,   English Cover Letter 2 ,   English Cover Letter 2 ,   Prenotification Letter - English ,   Prenotification Letter (Spanish) ,   Enrollee Survey Reminder Letter - Spanish

table that charts list of burden
  Total Request 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 97,505 105,010 0 -7,505 0 0
Annual Time Burden (Hours) 48,872 54,050 0 -5,178 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No