CMS-10710.GenIC#8 - High Impact Trust Survey Medicare

Generic Clearance for Improving Customer Experience: OMB Circular A–11, Section 280 Implementation) (CMS-10710)

Documents and Forms

Document Name Document Type
Form CMS-10710.GenIC #8 CMS-10710.GenIC#8 - High Impact Trust Survey Medicare Form and Instruction
CMS-10710.GenIC #8 High Impact Trust Survey Medicare (Instrument) CMS-10710.GenIC#8.High Impact Trust Survey Medicare (Instrument).docx Form and Instruction
CMS-10710.GenIC#8. ICR Template_A11 Section 280 Clearance.docx CMS-10710.GenIC#8. ICR Template_A11 Section 280 Clearance IC Document

Information Collection (IC) Details

IC Title:	CMS-10710.GenIC#8 - High Impact Trust Survey Medicare	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-10710.GenIC #8	High Impact Trust Survey Medicare (Instrument)	CMS-10710.GenIC#8.High Impact Trust Survey Medicare (Instrument).docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	10,000	10,000
Annual IC Time Burden (Hours)	500	500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
CMS-10710.GenIC#8. ICR Template_A11 Section 280 Clearance	CMS-10710.GenIC#8. ICR Template_A11 Section 280 Clearance.docx	03/06/2024

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