OMB control number

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (CMS-10415)

OMB 0938-1185 · HHS/CMS.

OMB 0938-1185

This collection of information is necessary to enable the Agency to garner customer and stakeholder feedback in an efficient, timely manner, in accordance with our commitment to improving service delivery. The information collected from our customers and stakeholders will help ensure that users have an effective, efficient, and satisfying experience with the agency's programs. This feedback will provide insights into customer or stakeholder perceptions, experiences and expectations, provide an early warning of issues with service, or focus attention on areas where communication, training or changes in operations might improve delivery of products or services. These collections will allow for ongoing, collaborative and actionable communications between the Agency and its customers and stakeholders. It will also allow feedback to contribute directly to the improvement of program management.

The latest form for Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (CMS-10415) expires 2026-04-30 and is listed under ICR 202211-0938-011.

View the official OMB control history on Reginfo.gov.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
Document	Type
Form CMS-10892 Emergency Medical Treatment and Labor Act (EMTALA) Complaint Form	Form and Instruction
Form CMS-10748 ACA Issuers Survey	Form
Form CMS-10748 Medicare Advantage Organization Survey	Form
Form CMS-10748 PACE Organization Survey	Form
Form CMS-10732 Customer and Stakeholder Feedback: Marketplace Consumer (Spanish)	Form
Form CMS-10732 Customer and Stakeholder Feedback: Providers/Suppliers (Spanish)	Form
Form CMS-10732 Customer and Stakeholder Feedback: SHIP or Other Assister or Partner (Spanish)	Form
Form CMS-10732 Customer and Stakeholder Feedback: Medicare Beneficiary (Spanish)	Form
Form CMS-10732 Customer and Stakeholder Feedback: All (Webinar)	Form and Instruction
Form CMS-10732 Customer and Stakeholder Feedback: SHIP or Other Assister or Partner	Form
Form CMS-10732 Customer and Stakeholder Feedback: Marketplace Consumer	Form
Form CMS-10732 Customer and Stakeholder Feedback: Medicare Beneficiary	Form
Form CMS-10732 Customer and Stakeholder Feedback: Providers/Suppliers	Form
Form CMS-10924 DevEx Survey (2026)	Form and Instruction
Form CMS-10719 MACBIS Software Application Electronic Survey	Form
Form CMS-10872 CMS Applicant Information Collection Form	Form and Instruction
Form CMS-10894 SBE Closeout	Form and Instruction
Form CMS-10894 Observation and Collaboration	Form and Instruction
Form CMS-10894 Conduct Reviews	Form and Instruction
Form CMS-10894 Data documentation Submission and Sampling	Form and Instruction
Form CMS-10894 Preparation: SBEs for IPPTA	Form and Instruction
Form CMS-10880 Focus Group Session Moderator Guide Script	Form and Instruction
Form CMS-10880 VRDC Survey Questions	Form and Instruction
Form CMS-10879 Post-Conference Event Feedback Request	Form and Instruction
Form CMS-10873 Post-Event/Post-Training Survey	Form and Instruction
Form CMS-10827 5 - CMS-10827. Mod Guide B - Open Payments Consumer (revised)	Form and Instruction
Form CMS-10827 CMS-10827. Mod Guide A - Open Payments Consumer (revised)	Form and Instruction
Form CMS-10827 3 - CMS-10827. Consent Form - Open Payments Consumer (revised)	Form and Instruction
Form CMS-10827 2 - CMS-10827. Recruitment Guide - Open Payments Consumer (revised)	Form and Instruction
Form CMS-10826 CMS-10826.Users-Checked Data (Physicians and Teaching Hospitals) (revised)	Form and Instruction
Form CMS-10826 CMS-10826.Health Care Providers (Primary Care and Specialist)	Form and Instruction
Form CMS-10826 CMS-10826.Recruitment Guide for Physicians and Other Health Care Providers	Form and Instruction
Form CMS-10826 CMS-10826.Recruitment Guide – Teaching Hospital Representatives	Form and Instruction
Form CMS-10864 Oral Health Survey Plan	Form and Instruction
Form CMS-10859 PSME Satisfaction Survey	Form and Instruction
Form CMS-10841 J.9 Customer Satisfaction Survey	Form and Instruction
Form CMS-10820 CMS OBRHI_Clinician Focus Groups_Eligibility Screener_Rev 20221007	Form and Instruction
Form CMS-10820 CMS-10820. CMS OBRHI_Clinician Focus Groups_Moderators Guide_Rev 20220803	Form and Instruction
Form CMS-10754 Observed Testing Protocol	Form and Instruction
Form CMS-10754 GADCS Feedback Application	Form and Instruction
Form CMS-10754 GADCS Draft Feedback Clean	Form and Instruction
Form CMS-10748 Account Manager Satisfaction Survey	Form
Form CMS-10729 CMS-10729 Beneficiary Care Management Program Beneficiary Satisfaction Survey	Form and Instruction
Form CMS-10723 CMS-10723.Patient Activation Assessment	Form and Instruction
Form CMS-10719 MACBIS Software Application Electronic Survey	Form
Form CMS-10415 End Stage Renal Disease (ESRD) Grievant Satisfaction Survey	Form and Instruction
Form CMS-10676 CMS-10676.Medicare.gov Sitewide Qualtrics Survey	Form and Instruction
Form CMS-10415 CMS-10415. Fast Track Medicaregov - Medicare Plan Finder Survey	Form and Instruction
Form CMS-10415 CMS-10415.Fast Track CMSgov Survey (2)	Form and Instruction
Form CMS-10415 IVR Phone Script	Form and Instruction
Fast Track - Blank Template.docx	Supplementary Document
CMS-10415_Supporting_Statement_Part_B.docx	Supporting Statement B
(0938-1185) CMS-10415.Supporting Statement A (30-day).docx	Supporting Statement A
Emergency Medical Treatment and Labor Act (EMTALA) Complaint Form (CMS-10892)	Form and Instruction
Account Manager Satisfaction Survey (CMS-10748)	Form
Account Manager Satisfaction Survey (CMS-10748)	Form
Account Manager Satisfaction Survey (CMS-10748)	Form
Account Manager Satisfaction Survey (CMS-10748)	Other-Other-Emails to Plan Sponsors
Surveying our Customers – Post-activity Evaluation (CMS-10732)	Form
Surveying our Customers – Post-activity Evaluation (CMS-10732)	Form
Surveying our Customers – Post-activity Evaluation (CMS-10732)	Form
Surveying our Customers – Post-activity Evaluation (CMS-10732)	Form
Surveying our Customers – Post-activity Evaluation (CMS-10732)	Form and Instruction
Surveying our Customers – Post-activity Evaluation (CMS-10732)	Form
Surveying our Customers – Post-activity Evaluation (CMS-10732)	Form
Surveying our Customers – Post-activity Evaluation (CMS-10732)	Form
Surveying our Customers – Post-activity Evaluation (CMS-10732)	Form
Blue Button 2.0 Developer Experience Customer Satisfaction Survey (CMS-10924)	Form and Instruction
MACBIS Software Application Electronic Surveys for Users -Webinar Survey Polling Questions (CMS-10719)	Form
Data Collection for Education and Outreach for the Yello System (CMS-10872)	Form and Instruction
Quality Improvement of IPPTA Processes and Procedures (CMS-10894)	Form and Instruction
Quality Improvement of IPPTA Processes and Procedures (CMS-10894)	Form and Instruction
Quality Improvement of IPPTA Processes and Procedures (CMS-10894)	Form and Instruction
Quality Improvement of IPPTA Processes and Procedures (CMS-10894)	Form and Instruction
Quality Improvement of IPPTA Processes and Procedures (CMS-10894)	Form and Instruction
CCW VRDC Stakeholder Engagement Plan (CMS-10880)	Form and Instruction
CCW VRDC Stakeholder Engagement Plan (CMS-10880)	Form and Instruction
Post Conference Event Feedback Request (CMS-10879)	Form and Instruction
Post-Acute Care Training Project (10873)	Form and Instruction
Health Care Consumer Feedback on Open Payments National Transparency Program (Open Payments) (CMS-10827)	Form and Instruction
Health Care Consumer Feedback on Open Payments National Transparency Program (Open Payments) (CMS-10827)	Form and Instruction
Health Care Consumer Feedback on Open Payments National Transparency Program (Open Payments) (CMS-10827)	Form and Instruction
Health Care Consumer Feedback on Open Payments National Transparency Program (Open Payments) (CMS-10827)	Form and Instruction
Health Care Provider Feedback on Open Payments National Transparency Program (Open Payments) - (CMS-10826)	Form and Instruction
Health Care Provider Feedback on Open Payments National Transparency Program (Open Payments) - (CMS-10826)	Form and Instruction
Health Care Provider Feedback on Open Payments National Transparency Program (Open Payments) - (CMS-10826)	Form and Instruction
Health Care Provider Feedback on Open Payments National Transparency Program (Open Payments) - (CMS-10826)	Form and Instruction
Oral Health Illustration Survey (CMS-10864)	Form and Instruction
Oral Health Illustration Survey (CMS-10864)	Other-Illustrations
Patient Subject Matter Expert (PSME) Satisfaction Survey (CMS-10859)	Form and Instruction
J.9 Network Satisfaction Survey (CMS-10841)	Form and Instruction
Clinician Focus Groups on Telehealth and Social Determinants of Health (CMS-10820)	Form and Instruction
Clinician Focus Groups on Telehealth and Social Determinants of Health (CMS-10820)	Form and Instruction
User Acceptance Testing for the Medicare Ground Ambulance Data Collection System (GADCS) - Observed Testing (CMS-10754)	Form and Instruction
User Acceptance Testing for the Medicare Ground Ambulance Data Collection System (GADCS) - Observed Testing (CMS-10754)	Form and Instruction
User Acceptance Testing for the Medicare Ground Ambulance Data Collection System (GADCS) - Observed Testing (CMS-10754)	Instruction
User Acceptance Testing for the Medicare Ground Ambulance Data Collection System (GADCS) (CMS-10754)	Form and Instruction
User Acceptance Testing for the Medicare Ground Ambulance Data Collection System (GADCS) (CMS-10754)	Instruction
Account Manager Satisfaction Survey (CMS-10748)	Form
Beneficiary Care Management Program, Beneficiary Experience Survey (CMS-10729)	Form and Instruction
12th SOW Patient Activation Assessment (CMS-10723)	Form and Instruction
MACBIS Software Application Electronic Surveys for Users (CMS-10719)	Form
End Stage Renal Disease Grievant Satisfaction Survey	Form and Instruction
Medicare.gov Sitewide Qualtrics (CMS-10676)	Form and Instruction
Medicare.gov Medicare Plan Finder Survey	Form and Instruction
CMS.gov User Satisfaction Survey	Form and Instruction
Beneficiary Contact Center Customer Satisfaction Survey	Form and Instruction

All Historical Document Collections

Historical document collections
Reference	Filing	Received	Action
202610-0938-001	Reinstatement with change of a previously approved collection	2026-10-14
202211-0938-011	Revision of a currently approved collection	2022-11-29	Approved with change
201904-0938-017	Revision of a currently approved collection	2019-04-30	Approved with change
201703-0938-009	No material or nonsubstantive change to a currently approved collection	2017-03-09	Withdrawn and continue
201611-0938-004	No material or nonsubstantive change to a currently approved collection	2016-11-10	Approved with change
201605-0938-002	No material or nonsubstantive change to a currently approved collection	2016-05-02	Approved with change
201512-0938-013	Revision of a currently approved collection	2015-12-30	Approved with change
201508-0938-014	No material or nonsubstantive change to a currently approved collection	2015-08-28	Withdrawn and continue
201506-0938-013	No material or nonsubstantive change to a currently approved collection	2015-06-26	Approved without change
201412-0938-006	No material or nonsubstantive change to a currently approved collection	2014-12-17	Approved without change
201210-0938-003	New collection (Request for a new OMB Control Number)	2012-10-01	Approved without change
201206-0938-002	New collection (Request for a new OMB Control Number)	2012-06-08	Improperly submitted