Information Collection

CMS-10710.GenIC#4 - Healthcare.gov Web Satisfaction Survey (A11 Section 280)

IC 262619 under ICR 202609-0938-011 · OMB 0938-1382.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10710.GenIC#4 CMS-10710.GenIC#4 - Healthcare.gov_Web_Sat_Survey (A11 Section 280) CMS-10710.GenIC#4 - Healthcare.gov Web Satisfaction Survey (A11 Section 280)	Form and Instruction
CMS-10710.GenIC#4 CMS-10710.GenIC#4 - Healthcare.gov_Web_Sat_Survey (A11 S CMS-10710#4 - Healthcare.gov_Web_Sat_Survey (A11 Section 280) (30-day).pdf	Form and Instruction
CMS-10710#4 - Healthcare.gov_Web_Sat_Survey (A11 Section 280) (30-day).docx CMS-10710#4 - Healthcare.gov_Web_Sat_Survey (A11 Section 280) (30-day)	IC Document

IC Title:

Agency IC Tracking Number:

IC Status: Modified

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-10710.GenIC#4				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 24,000

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	Previously Approved
Annual Number of Responses for this IC	24,000	24,000
Annual IC Time Burden (Hours)	1,600	1,600
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
CMS-10710#4 - Healthcare.gov_Web_Sat_Survey (A11 Section 280) (30-day)		09/30/2023

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

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