CMS-10818 Track Existing Ticket

Generic Clearance for the Center for Clinical Standards and Quality IT Product and Support Teams (CMS-10706)

CMS-10818 Track Existing Ticket - CCSQ Support Central Survey Mock-ups

Center for Clinical Standards and Quality (CCSQ) Support Central Customer Satisfaction Survey (CMS-10818)

OMB: 0938-1397

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Ticket Information
Showing ticket records for: John Doe
Survey Invitation

CS0001004
John Doe

Would you like to participate in a quick survey?

State

Closed

Reason for contacting us:

This should take about 2 minutes to complete.

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Created
3d ago
PRA Disclosure
Statement
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Last Updated
8h ago Reduction Act of 1995,accusam
According to the Paperwork
no persons
areduo
required
a collection
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of information unless
it displays a valid OMB control number. The valid OMB control number for this
Subject
XXXXXXXX
Priority

4 - Low

information collection is 0938-XXXX (Expires XX/XX/XXXX). This is a voluntary information collection.
The time required to complete this information collection is estimated to average two minutes per
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sadipscing
sed diam nonumy
eirmod tempor
invidunt ut gather
labore etthe
dolore
response,
the time to
review elitr,
instructions,
search existing
data resources,
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erat, sed
diam.
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ut labore
et the
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See More the
needed,
and
complete
review
information
collection.
If you
haveeirmod
comments
concerning
accuracy of the time estimate(s) or suggestions for improving this form, please write to:
Close notes:

Ticket Activity

CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Oﬃcer, Mail Stop C4-26-05,
Baltimore, Maryland 21244-1850
John Doe (You)
2021-10-18 00:16:19

****CMS Disclosure****
Opened
case.
Please do not send applications, claims, payments, medical records
or any
documents containing sensitive
information to the PRA Reports Clearance Oﬃce. Please note that any correspondence not pertaining to the
information
burden approved under the associated OMB control number listed on this form will not
System Administrator
Amar
Kaurcollection
2021-10-18
be reviewed,
00:16:19
forwarded, or retained. If you have questions or concerns regarding where to submit your
documents, please contact John Vancil – [email protected].
Has received case.

Amar Kaur

System Administrator

Start Survey

2021-10-18 00:16:19
Amar has closed this ticket

The ticket is closed and no comments can be added. If you have any questions regarding this ticket,
please contact the CCSQ Service Center by creating a new ticket on the request support page.

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Ticket Information
Showing ticket records for: John Doe

CS0001004
John Doe
State

Closed

Reason for contacting us:

Priority

4 - Low

Created

3d ago

Last Updated

8h ago

Subject

XXXXXXXX

Lorem ipsum dolor sit amet, consetetur sadipscing elitr, sed
diam nonumy eirmod tempor invidunt ut labore et dolore
magna aliquyam erat, sed diam voluptua. At vero eos et
accusam et justo duo dolores et ea rebum. Stet clita kasd
gubergren. See More

Close notes:
Lorem ipsum dolor sit amet, consetetur sadipscing elitr, sed diam nonumy eirmod tempor invidunt ut labore et dolore magna
aliquyam erat, sed diam. Invidunt ut labore et dolore magna aliquyam erat, sed nonumy eirmod tempor. See More

Ticket Activity
John Doe

(You)

2021-10-18 00:16:19
Opened case.

Amar Kaur

System Administrator

2021-10-18 00:16:19
Has received case.

Amar Kaur

System Administrator

2021-10-18 00:16:19
Amar has closed this ticket

The ticket is closed and no comments can be added. If you have any questions regarding this ticket,
please contact the CCSQ Service Center by creating a new ticket on the request support page.

Subscribe to a CMS Newsletter

Provide Site Feedback

Help us improve this website by providing
your feedback in a short survey.

Sign Me Up

Give Feedback

About

Programs

Accessiblity

QPP

Accessibility

Technical Support

iQIES/QIES
EQRS
HQR

I Have a Question

About

**Click here to go back to homepage**

Ticket Information
Showing ticket records for: John Doe

CS0001004
John Doe
State

You're Almost Done.
Closed

Priority

Close
Reason for contacting us:

Lorem ipsum dolor sit amet, consetetur sadipscing elitr, sed
diam nonumy eirmod tempor invidunt ut labore et dolore
Are you
sure
you
want
to
exit
the survey?
3d ago
magna aliquyam erat, sed diam voluptua. At vero eos et
accusam et justo duo dolores et ea rebum. Stet clita kasd
agoyou to stay. Your feedback
We'd like8hfor
is important
to us.
gubergren.
See More
XXXXXXXX
4 - Low

Created
Last Updated
Subject
Close notes:

Exit

Continue Survey

Lorem ipsum dolor sit amet, consetetur sadipscing elitr, sed diam nonumy eirmod tempor invidunt ut labore et dolore magna
aliquyam erat, sed diam. Invidunt ut labore et dolore magna aliquyam erat, sed nonumy eirmod tempor. See More

Ticket Activity
John Doe

(You)

2021-10-18 00:16:19
Opened case.

Amar Kaur

System Administrator

2021-10-18 00:16:19
Has received case.

Amar Kaur

System Administrator

2021-10-18 00:16:19
Amar has closed this ticket

The ticket is closed and no comments can be added. If you have any questions regarding this ticket,
please contact the CCSQ Service Center by creating a new ticket on the request support page.

Subscribe to a CMS Newsletter

Provide Site Feedback

Help us improve this website by providing
your feedback in a short survey.

Sign Me Up

Give Feedback

About

Programs

Accessiblity

QPP

Accessibility

Technical Support

iQIES/QIES
EQRS
HQR

I Have a Question

About

**Click here to go back to homepage**

Ticket Information
Showing ticket records for: John Doe

CS0001004
John Doe

Thank
you for your feedback!
Closed
Reason for contactingClose
us:

State

Lorem ipsum dolor sit amet, consetetur sadipscing elitr, sed
Thank your for completing out survey.diam
Yournonumy
opinions
matter
eirmod
tempor invidunt ut labore et dolore
3d ago
aliquyam erat, sed diam voluptua. At vero eos et
to us and will help improve the overallmagna
experience.
accusam et justo duo dolores et ea rebum. Stet clita kasd
8h ago
gubergren. See More
XXXXXXXX

Priority

4 - Low

Created
Last Updated
Subject
Close notes:

Ticket Activity
John Doe

(You)

2021-10-18 00:16:19
Opened case.

Amar Kaur

System Administrator

2021-10-18 00:16:19
Has received case.

Amar Kaur

System Administrator

2021-10-18 00:16:19
Amar has closed this ticket

The ticket is closed and no comments can be added. If you have any questions regarding this ticket,
please contact the CCSQ Service Center by creating a new ticket on the request support page.

Subscribe to a CMS Newsletter

Provide Site Feedback

Help us improve this website by providing
your feedback in a short survey.

Sign Me Up

Give Feedback

About

Programs

Accessiblity

QPP

Accessibility

Technical Support

iQIES/QIES
EQRS
HQR

We appreciate your feedback!
We appreciate your feedback!

*How easy was it to create a ticket?

Please rate your ability to create a ticket on our website:

Easy

Normal

Challenging

*How much do you agree with this statement?
The amount of time it took to create a ticket was reasonable.
Agree
Neither Agree or Disagree
Disagree

*Which program are you aﬃliated with?
Please select the program you are apart of:
EPCS - Electronic Prescribing for Controlled Substances
EQRS - End Stage Renal Disease Quality Reporting System
HQR - Hospital Quality Reporting
iQIES/QIES - Quality Improvement/Internet Quality Improvement &
Evaluation System
QPP - Quality Payment Program
CCSQ Services and Operations Support - QualityNet IT Services,
HARP, CCSQ Atlassian, ServiceNow & Slack
Other: (Please specify)

*How could we improve your next visit?
We value your insight!
I had a great experience!
I have a suggestion.

Please specify:

*Can we contact you with further questions?
May we contact you if we have additional questions?
Yes.

Please provide your contact details below:
Full Name:

Email Address:

No, thank you.

Complete

File Type	application/pdf
File Modified	2022-07-22
File Created	0000-00-00