OMB control number
Medicare Plan Performance Warning Information (CMS-10836)
OMB 0938-1456 · HHS/CMS.
OMB 0938-1456
The Centers for Medicare & Medicaid Services (CMS) is seeking approval to collect information to assist in the Agency’s response to two reports from the Department of Health and Human Services Office of the Inspector General (OIG) related to how the agency conveys information on plan performance. CMS is conducting this research to respond to OIG’s recommendations related to sharing clear and accessible information with beneficiaries on plan performance, particularly related to information which may warn or caution beneficiaries about plan performance issues. CMS is seeking to learn more about how beneficiaries, caregivers, and the intermediaries who assist them use and understand the information CMS currently makes (or may make) available, as well as to assess their interest in accessing this information.
The latest form for Medicare Plan Performance Warning Information (CMS-10836) expires 2026-12-31 and is listed under ICR 202303-0938-005.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form CMS-10836 IDI Discussion Guide | Form and Instruction |
| Form CMS-10836 Scheduling/Screening | Form and Instruction |
 CMS-10836 -Supporting Statement A -.docx | Supporting Statement A |
 IDI Discussion Guide |
Form and Instruction |
| Scheduling/Screening |
Form and Instruction |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202303-0938-005 | New collection (Request for a new OMB Control Number) | 2023-03-15 | Approved with change |
OMB Details
Scheduling/Screening
Federal Enterprise Architecture: Health - Health Care Services
| Form | Name | Electronic access | Type |
|---|---|---|---|
| Form CMS-10836 | Interview Screener: Typical and Engaged Beneficiaries | Fillable Fileable | Form and instruction |
| Form CMS-10836 | Interview Screener: Typical Beneficiaries: Caregivers | Fillable Fileable | Form and instruction |
Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.