Information Collection

CMS-10710.GenIC#5 - Medicare.gov Web Sat Survey (A11 Section 280)

IC 262620 under ICR 202402-0938-008 · OMB 0938-1382.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10710.GenIC#5 CMS-10710.GenIC#5 - Medicare.gov Web Sat Survey (A11 Section 280)	Form and Instruction
Form CMS-10710.GenIC#5 CMS-10710#5 - Medicare.gov Web Sat Survey (A11 Section 280) CMS-10710.GenIC#5 - Medicare.gov Web Sat Survey (A11 Section 280)	Form and Instruction
CMS-10710.GenIC#5 CMS-10710#5 - Medicare.gov Web Sat Survey (A11 Section 2 CMS-10710#5 - Medicare.gov Web Sat Survey (A11 Section 280) (30-day).pdf	Form and Instruction
CMS-10710.GenIC#5 CMS-10710#5 - Medicare.gov Web Sat Survey (A11 Section 2 CMS-10710#5 - Medicare.gov Web Sat Survey (A11 Section 280) (30-day).pdf	Form and Instruction
CMS-10710#5 - Medicare.gov Web Sat Survey (A11 Section 280) (30-day).docx CMS-10710#5 - Medicare.gov Web Sat Survey (A11 Section 280) (30-day)	IC Document
CMS-10710#5 - Medicare.gov Web Sat Survey (A11 Section 280) (30-day).docx CMS-10710#5 - Medicare.gov Web Sat Survey (A11 Section 280) (30-day)	IC Document

IC Title:

Agency IC Tracking Number:

IC Status: Unchanged

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-10710.GenIC#5	CMS-10710#5 - Medicare.gov Web Sat Survey (A11 Section 280)	CMS-10710#5 - Medicare.gov Web Sat Survey (A11 Section 280) (30-day).pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 360,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	360,000	360,000
Annual IC Time Burden (Hours)	24,000	24,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
CMS-10710#5 - Medicare.gov Web Sat Survey (A11 Section 280) (30-day)	CMS-10710#5 - Medicare.gov Web Sat Survey (A11 Section 280) (30-day).docx	09/30/2023

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