Information Collection

Reporting for the Enrollee Satisfaction Survey (ESS)

IC 212994 under ICR 202508-0938-006 · OMB 0938-1249.

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Information Collection (IC) Details

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IC Title:	Reporting for the Enrollee Satisfaction Survey (ESS)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 45 CFR 156.200(b)(5) 45 CFR 155.200(d) 45 CFR 1120-1125 45 CFR 156.1105 (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 380	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	380	80	300
Annual IC Time Burden (Hours)	19,000	4,000	15,000
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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

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