Information Collection

GenIC #28 Health Insurance Literacy Survey

IC 269722 under ICR 202407-0938-019 · OMB 0938-1247.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10437.GenIC#28 GenIC #28 Health Insurance Literacy Survey	Form and Instruction
CMS-10437.GenIC#28 Marketplace and Medicare Health Insurance Literacy Surve CMS-10437.GenIC#28.Survey Instrument - final.docx	Form and Instruction
CMS-10437.GenIC#28 Marketplace and Medicare Health Insurance Literacy Surve CMS-10437.GenIC#28.Survey Instrument - final.docx	Form and Instruction
CMS-10437.GenIC#28.Supporting Statement - final.docx CMS-10437.GenIC#28.Supporting Statement - final	IC Document
CMS-10437.GenIC#28.Supporting Statement - final.docx CMS-10437.GenIC#28.Supporting Statement - final	IC Document
CMS-10437.GenIC#28.Cover Sheet - final.docx CMS-10437.GenIC#28.Cover Sheet - final	IC Document
CMS-10437.GenIC#28.Cover Sheet - final.docx CMS-10437.GenIC#28.Cover Sheet - final	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-10437.GenIC#28	Marketplace and Medicare Health Insurance Literacy Survey	CMS-10437.GenIC#28.Survey Instrument - final.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,400

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,400	2,400
Annual IC Time Burden (Hours)	600	600
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
CMS-10437.GenIC#28.Supporting Statement - final	CMS-10437.GenIC#28.Supporting Statement - final.docx	08/06/2024
CMS-10437.GenIC#28.Cover Sheet - final	CMS-10437.GenIC#28.Cover Sheet - final.docx	08/06/2024

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