Information Collection

GenIC #12 – Usability and Cognitive Testing: HC.gov Application Enhancements for DACA Recipients

IC 271246 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#12 CMS-10710.GenIC#12 - DACA - Instrument GenIC #12 – Usability and Cognitive Testing: HC.gov Application Enhancements for DACA Recipients	Form and Instruction
CMS-10710#12 CMS-10710.GenIC#12 - DACA - Instrument CMS-10710.GenIC#12 - DACA - Instrument.docx	Form and Instruction
CMS-10710.GenIC_#12 - ICR_Template_A11_Section 280.docx CMS-10710.GenIC_#12 - ICR_Template_A11_Section 280	IC Document
CMS-10710.GenIC#12 - HIX V_DACA_Prototype Structure & Flow with Language_09 20 2024.pdf CMS-10710.GenIC#12 - HIX V_DACA_Prototype Structure & Flow with Language_09 20 2024	IC Document

IC Title:

GenIC #12 â Usability and Cognitive Testing: HC.gov Application Enhancements for DACA Recipients

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#12				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 48

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	48	48
Annual IC Time Burden (Hours)	48	48
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
CMS-10710.GenIC_#12 - ICR_Template_A11_Section 280		09/27/2024
CMS-10710.GenIC#12 - HIX V_DACA_Prototype Structure & Flow with Language_09 20 2024		09/27/2024

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

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