Information Collection

Website Page Feedback Form: Find Local Help on https://www.healthcare.gov (CMS-10962)

IC 280410 under ICR 202609-0938-011 · OMB 0938-1382.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS_10962 CMS-10962.ENGLISH FLH Page Form Survey Website Page Feedback Form: Find Local Help on https://www.healthcare.gov (CMS-10962)	Form and Instruction
Form CMS-10962 CMS-10962. SPANISH_FLH Page Form Survey Website Page Feedback Form: Find Local Help on https://www.healthcare.gov (CMS-10962)	Form and Instruction
CMS_10962 CMS-10962.ENGLISH FLH Page Form Survey CMS-10962.ENGLISH FLH Page Form Survey.docx	Form and Instruction
CMS-10962 CMS-10962. SPANISH_FLH Page Form Survey CMS-10962. SPANISH_FLH Page Form Survey.docx	Form and Instruction
CMS-10962. A11-280 Submission for Website Page Feedback Form - Find Local Help on www.healthcare.gov.docx CMS-10962. A11-280 Submission for Website Page Feedback Form - Find Local Help on www.healthcare.gov	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_10962				Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10962				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 550

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	550	550
Annual IC Time Burden (Hours)	18	18
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
CMS-10962. A11-280 Submission for Website Page Feedback Form - Find Local Help on www.healthcare.gov		05/12/2026

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

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