Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
(CMS-10626) End Stage Renal Disease Quality Reporting System (EQRS) Customer Satisfaction and Task Prioritization Survey for the EQRS Release 1.0 Project. New 200 50 0 Form and Instruction CMS-10626 CrownWeb Facility User Survey
Beneficiary Contact Center Customer Satisfaction Survey Unchanged 145000 5776 0 Form and Instruction CMS-10415 IVR Phone Script for Survey
Cognitive Testing for the Marketplace Dental Survey (CMS-10591) Unchanged 48 48 0 Form and Instruction CMS-10591 Marketplace Dental Survey Cognitive Testing Eligibility Screener
End Stage Renal Disease (ESRD) Grievant Satisfaction Survey (IC#5) - Round 2 Unchanged 384 77 0 Form and Instruction GenIC#5 ESRD Greivant Satisfaction Survey Version 2.0
Evaluation of Stakeholder Training - Health Insurance Marketplace and Market Stabilization Programs Unchanged 100000 417 0 Form and Instruction CMS-10415 Stakeholder Training Forms
Medicare Part D Beneficiaries' Satisfaction on Potential Process Changes Associated With Comprehensive Medication Reviews (CMRs) and Targeted Medication Reviews (TMRs) (CMS-10396) Unchanged 50 17 0 Form and Instruction CMS-10396 Telephone Interview Script
Other-Other-Visual Aid #2 ? Medication Action Plan Mockup
Other-Beneficiary Solicitation Letter
Other-Visual Aid #3 ? Personal Medication List Mockup
Other-Visual Aid #1 ? Medicare & You 2016 MTM Pages
QualityNet.org and QualityNet Secure Portal Customer Satisfaction and Task Prioritization Survey for Phase 1 of the QualityNet Portal (QNP) redesign project (CMS-10590) Unchanged 500 83 0 Form and Instruction CMS-10590 Quality Net User Survey
Reporting for the Health Insurance Marketplace and Qualified Health Plan Enrollee Experience Surveys: Health Insurance Marketplace Consumer Experience Surveys Project (CMS-10534) Unchanged 90 106 0 Form and Instruction CMS-10534 Cognitive Interview Guide, Screener and Consent Forms
Usability Testing and Evaluation for Phase 1 of the QualityNet Portal (QNP) Redesign Project (CMS-10588) Unchanged 40 32 0 Form and Instruction CMS-10588 Usability Test Script
Total Burden Actually Used for Information Collections Under Currently Approved ICR: 246312 6606 0  
Total Burden Currently Requested for Information Collections Under Currently Approved ICR: 0 0 0  
To view an IC, click on IC Title