Information Collection

Medicare Advantage (MA) Survey

IC 8404 under ICR 202505-0938-018 · OMB 0938-0732.

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
Form CMS-R-246 Medicare Advantage Plan Survey Medicare Advantage (MA) Survey	Form and Instruction
Form CMS-R-246 Medicare Advantage Plan Survey - Chinese Medicare Advantage (MA) Survey	Form and Instruction
Form CMS-R-246 Medicare Advantage Plan Survey - Korean Medicare Advantage (MA) Survey	Form and Instruction
Form CMS-R-246 Medicare Advantage Plan Survey - Spanish Medicare Advantage (MA) Survey	Form and Instruction
Form CMS-R-246 Medicare Advantage Plan Survey - Tagalog Medicare Advantage (MA) Survey	Form and Instruction
Form CMS-R-246 Medicare Advantage Plan Survey - Vietnamese Medicare Advantage (MA) Survey	Form and Instruction
CMS-R-246 Medicare Advantage Plan Survey 2026-MA-Only-Survey_clean .docx	Form and Instruction
CMS-R-246 Medicare Advantage Plan Survey 2026-MA-Only-Survey_clean .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
2026-MA-Only-Survey_redline.pdf Track Change version	IC Document
2026-MA-Only-Survey_redline.pdf Track Change version	IC Document

Information Collection (IC) Details

View Information Collection (IC)

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.	Available Electronically?	Electronic Capability
Form and Instruction	CMS-R-246	No	Fillable Printable
Form and Instruction	CMS-R-246	No	Fillable Printable
Form and Instruction	CMS-R-246	No	Fillable Printable
Form and Instruction	CMS-R-246	No	Fillable Printable
Form and Instruction	CMS-R-246	No	Fillable Printable
Form and Instruction	CMS-R-246	No	Fillable Printable

Federal Enterprise Architecture Business Reference Module

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
Track Change version		06/05/2025

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

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