Information Collection

Medicare Advantage (MA) Survey

IC 8404 under ICR 202406-0938-010 · OMB 0938-0732.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0732 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-R-246 Medicare Advantage (MA) Survey	Form and Instruction
CMS-R-246 Medicare Advantage Plan Survey 2025-MA-Only-Survey.docx	Form and Instruction
CMS-R-246 Medicare Advantage Plan Survey 2025-MA-Only-Survey.docx	Form and Instruction
CMS-R-246 Medicare Advantage Plan Survey - Chinese 2025-MA-Only-Survey-Chinese.pdf	Form and Instruction
CMS-R-246 Medicare Advantage Plan Survey - Chinese 2025-MA-Only-Survey-Chinese.pdf	Form and Instruction
CMS-R-246 Medicare Advantage Plan Survey - Korean 2025-MA-Only-Survey-Korean.pdf	Form and Instruction
CMS-R-246 Medicare Advantage Plan Survey - Korean 2025-MA-Only-Survey-Korean.pdf	Form and Instruction
CMS-R-246 Medicare Advantage Plan Survey - Spanish 2025-MA-Only-Survey-Spanish.pdf	Form and Instruction
CMS-R-246 Medicare Advantage Plan Survey - Spanish 2025-MA-Only-Survey-Spanish.pdf	Form and Instruction
CMS-R-246 Medicare Advantage Plan Survey - Tagalog 2025-MA-Only-Survey-Tagalog.pdf	Form and Instruction
CMS-R-246 Medicare Advantage Plan Survey - Tagalog 2025-MA-Only-Survey-Tagalog.pdf	Form and Instruction
CMS-R-246 Medicare Advantage Plan Survey - Vietnamese 2025-MA-Only-Survey-Vietnamese.pdf	Form and Instruction
CMS-R-246 Medicare Advantage Plan Survey - Vietnamese 2025-MA-Only-Survey-Vietnamese.pdf	Form and Instruction

IC Title:

Medicare Advantage (MA) Survey

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 417.472 42 CFR 422.152 42 CFR 422.156

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form and Instruction	CMS-R-246	Medicare Advantage Plan Survey	2025-MA-Only-Survey.docx	No	Fillable Printable
Form and Instruction	CMS-R-246	Medicare Advantage Plan Survey - Chinese	2025-MA-Only-Survey-Chinese.pdf	No	Fillable Printable
Form and Instruction	CMS-R-246	Medicare Advantage Plan Survey - Korean	2025-MA-Only-Survey-Korean.pdf	No	Fillable Printable
Form and Instruction	CMS-R-246	Medicare Advantage Plan Survey - Spanish	2025-MA-Only-Survey-Spanish.pdf	No	Fillable Printable
Form and Instruction	CMS-R-246	Medicare Advantage Plan Survey - Tagalog	2025-MA-Only-Survey-Tagalog.pdf	No	Fillable Printable
Form and Instruction	CMS-R-246	Medicare Advantage Plan Survey - Vietnamese	2025-MA-Only-Survey-Vietnamese.pdf	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: Privacy Act of 1974: HPMS # 09-70-4004

FR Citation: 63 FR 43187

Number of Respondents: 440,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	440,000	440,000
Annual IC Time Burden (Hours)	110,000	110,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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