Information Collection

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

IC 265830 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 #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

IC Title:

Agency IC Tracking Number:

IC Status: New

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 #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 %

table that charts list of burden
	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

table that charts IC Documents
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.