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. Unchanged 200 50 0 Form and Instruction CMS-10626 CrownWeb Facility User Survey
(CMS-10685) E-mail Feedback Regarding Psychiatric Facility Quality Measure Strategies New 179 15 0 Form and Instruction CMS-10685 LAN member best practices email
(CMS-10686) 2018 Resource Assessment New 9682 808 0 Form and Instruction CMS-10686 Resource Assessment
Beneficiary Contact Center Customer Satisfaction Survey Unchanged 145000 5776 0 Form and Instruction CMS-10415 IVR Phone Script for Survey
CMS-10676.Medicare.gov Sitewide Qualtrics Survey New 100000 8333 0 Form and Instruction CMS-10676 Medicare.gov Sitewide Qualtrics Survey
CMS.gov User Satisfaction Survey New 10000 333 0 Form and Instruction CMS-10415 CMS.gov User Satisfaction 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
Electronic Medical Documentation Interoperability (EMDI) Workgroup Survey New 120 40 0 Form CMS-10679 EMDI Workgroup Participation Survey
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
Evaluating the Users Experience Accessing Public Data Made Available at CMS.gov (CMS-10689) New 35 35 0 Form and Instruction CMS-10689 CMS-10689. OEDA_UserResearchScriptWDDSE
Evaluating the Users Experience Accessing Public Data Made Available at CMS.gov (CMS-10698) New 400 67 0 Form and Instruction CMS-10698 Evaluating the Users Experience Accessing Public Data Made Available at CMS.gov
Evaluation of Stakeholder Training - Health Insurance Marketplace and Market Stabilization Programs Unchanged 100000 417 0 Form and Instruction CMS-10415 Stakeholder Training Forms
MIPS Feedback Request: 8 Quick Multiple Choice Questions (CMS-10683) New 2793 186 0 Form and Instruction CMS-10683 MIPS Feedback Request: 8 Quick Multiple Choice Questions
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
Medicare Plan Finder User Satisfaction Survey New 25000 833 0 Form and Instruction CMS-10415 CMS-10415. Fast Track Medicaregov - Medicare Plan Finder Survey
MyMedicare.gov User Satisfaction Survey New 6000 200 0 Form and Instruction CMS-10415 MyMedicare.gov Survey
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
Unmoderated Online User Testing of a Proposed New CMS.gov Website Structure (CMS-10682) New 50 13 0 Form CMS-10682 CMS_OCS_TestingQuestions_SitemapTesting-updated (002).docx
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
User Experience Design Validation for Accessing Public Data Made Available at CMS.gov (CMS-10700) New 70 70 0 Form and Instruction CMS-10700 Wireframes for Design Validation
Form and Instruction CMS-10700 Discussion Guide
Total Burden Actually Used for Information Collections Under Currently Approved ICR: 400641 17539 0  
Total Burden Currently Requested for Information Collections Under Currently Approved ICR: 0 0 0  
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