Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
(CMS-10546) Survey for Long-Term (LT) and Post-Acute Care (PAC) Electronic Health Records (EHR) and Health Information Exchange (HIE) Adoption New 34328 11443 0 Form and Instruction CMS-10546
(CMS-10560) Focus Groups to Inform the Development of a Marketplace Dental Survey New 36 72 0 Form and Instruction CMS-10560
Beneficiary Contact Center Customer Satisfaction Survey Unchanged 145000 5776 0 Form and Instruction CMS-10415
Development, Adaptation, Implementation, and Maintenance of Quality Measures for the Programs of All-Inclusive Care for the Elderly (PACE) (CMS-10557) New 46 4035 0 Form CMS-10557
Other-Recruitment Reminder Letter
Other-Recruitment Letter
Development, Adaptation, Implementation, and Maintenance of Quality Measures for the Programs of All-Inclusive Care for the Elderly (PACE) (CMS-10557) New 60 1 0 Form CMS-10557
End Stage Renal Disease (ESRD) Grievant Satisfaction Survey (IC#5) Modified 384 77 0 Form and Instruction GenIC #5
Evaluation of Stakeholder Training - Health Insurance Marketplace and Market Stabilization Programs Unchanged 100000 417 0 Form and Instruction 0938-1185
Health Care Payment Learning and Action Network (CMS-10559) New 1000 100 0 Form and Instruction CMS-10559
Instrument for Soliciting Feedback on Satisfaction With, and Changes to, the Standardized Format (Medication Therapy Management Program Improvements; CMS-10396, OMB No. 0938-1154) (GenIC#6) New 30 10 0 Form and Instruction Beneficiary Telephone Interview Script
Other-Medicare Beneficiary Mailed Solicitation Letter
Peer Coach Assessment New 36 6 0 Instruction
Other-Link to Instrument
Quality Reporting Process Survey (CMS-10562) New 50 25 0 Form and Instruction CMS-10562
Reporting for the Health Insurance Marketplace and Qualified Health Plan Enrollee Experience Surveys: Health Insurance Marketplace Consumer Experience Surveys Project Unchanged 90 106 0 Form and Instruction CMS-10534
Usability Testing for the Health Insurance Marketplace Websites: Health Insurance Marketplave Consumer Experiernce Surveys Project Unchanged 90 135 0 Form and Instruction CMS-10533
Total Burden Actually Used for Information Collections Under Currently Approved ICR: 281150 22203 0  
Total Burden Currently Requested for Information Collections Under Currently Approved ICR: 0 0 0  
To view an IC, click on IC Title