Information Collection

Medicare Advantage Beneficiary Customer Satisfaction Survey for Complaint Resolution (CMS-10970)

IC 281004 under ICR 202609-0938-011 · OMB 0938-1382.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10970 Medicare Advantage Beneficiary Customer Satisfaction Survey for Complaint Resolution Medicare Advantage Beneficiary Customer Satisfaction Survey for Complaint Resolution (CMS-10970)	Form and Instruction
CMS-10970 Medicare Advantage Beneficiary Customer Satisfaction Sur CMS-10970.Medicare_Advantage_Customer_Satisfaction_Survey.docx	Form and Instruction
CMS-10970.ICR Submission Template A11-280.docx CMS-10970.ICR Submission Template A11-280	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-10970				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: Health Plan Management System (HPMS) (SORN # 09-70-0500)

FR Citation: 83 FR 6591

Number of Respondents: 5,000

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	5,000	5,000
Annual IC Time Burden (Hours)	167	167
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
CMS-10970.ICR Submission Template A11-280		06/16/2026

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

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