OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

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

IC 267554 under ICR 202405-0938-010 · OMB 0938-1397.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Form CMS-10818
Center for Clinical Standards and Quality (CCSQ) Support Central Customer Satisfaction Survey (CMS-10818)		 Form and Instruction
CMS-10818 Call Scheduling
CMS-10818 Call Scheduling - CCSQ Suppot Central Survey Mock-ups.pdf 		Form and Instruction
CMS-10818 Call Scheduling
CMS-10818 Call Scheduling - CCSQ Suppot Central Survey Mock-ups.pdf 		Form and Instruction
CMS-10818 Create A Ticket
CMS-10818 Create A Ticket - CCSQ Support Central Survey Mock-ups.pdf 		Form and Instruction
CMS-10818 Create A Ticket
CMS-10818 Create A Ticket - CCSQ Support Central Survey Mock-ups.pdf 		Form and Instruction
CMS-10818 Live Chat
CMS-10818 Live Chat - CCSQ Support Central Survey Mock-ups.pdf 		Form and Instruction
CMS-10818 Live Chat
CMS-10818 Live Chat - CCSQ Support Central Survey Mock-ups.pdf 		Form and Instruction
CMS-10818 Track Existing Ticket
CMS-10818 Track Existing Ticket - CCSQ Support Central Survey Mock-ups.pdf 		Form and Instruction
CMS-10818 Track Existing Ticket
CMS-10818 Track Existing Ticket - CCSQ Support Central Survey Mock-ups.pdf 		Form and Instruction
CMS-10818 CCSQ Support Central Surveys Supporting Statement.docx
Supporting Statement		IC Document
CMS-10818 CCSQ Support Central Surveys Supporting Statement.docx
Supporting Statement		IC Document

Information Collection (IC) Details

View Information Collection (IC)

layout table

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-10818 Call Scheduling CMS-10818 Call Scheduling - CCSQ Suppot Central Survey Mock-ups.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10818 Create A Ticket CMS-10818 Create A Ticket - CCSQ Support Central Survey Mock-ups.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10818 Live Chat CMS-10818 Live Chat - CCSQ Support Central Survey Mock-ups.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10818 Track Existing Ticket CMS-10818 Track Existing Ticket - CCSQ Support Central Survey Mock-ups.pdf Yes Yes Fillable Fileable

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 2,800 0 2,800 0 0 0
Annual IC Time Burden (Hours) 93 0 93 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Documents for IC
table that charts IC Documents
Title Document Date Uploaded
Supporting Statement CMS-10818 CCSQ Support Central Surveys Supporting Statement.docx 05/09/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.