Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
(CMS-10723) 12SOW Patient Activiation Assessment New 100000 3333 0 Form and Instruction CMS-10723
(CMS-10776) IPRO 2020 Collaborator Satisfaction Survey-Request for Approval-Nursing Homes New 964 161 0 Form and Instruction CMS-10776
Account Manager Satisfaction Survey (CMS-10748) New 300 50 0 Form CMS-10748
Account Manager Satisfaction Survey (CMS-10748) New 300 5 0 Form CMS-10748
Beneficiary Care Management Program, Beneficiary Experience Survey (CMS-10729) New 600 50 0 Form and Instruction CMS-10729
Beneficiary Contact Center Customer Satisfaction Survey New 145000 5776 0 Form and Instruction CMS-10415
CMS-10726 Survey Refinement for the Qualified Health Plan Enrollee Experience Survey New 40 90 0 Form and Instruction CMS-10726
Form and Instruction CMS-10726
Form and Instruction CMS-10726
CMS-10760.Overall Flu Campaign Feedback Survey New 4872 81 0 Form and Instruction CMS-10760
CMS-10761. Medicare Administrative Contractor (MAC) Provider Customer Experience – Mobile Application New 500 25 0 Form and Instruction CMS-10761
Form and Instruction CMS-10761
CMS-10762. Medicare Administrative Contractor (MAC) Provider Experience Persistent Feedback – Mobile Application New 500 8 0 Form and Instruction CMS-10762
Form and Instruction CMS-10762
CMS-10763.Medicare Administrative Contactors Customer Experience – Medical Review New 3000 150 0 Form and Instruction CMS-10763
Form and Instruction CMS-10763
CMS-10766. COVID-19 Campaign Survey on Fee-for-Service CMS.gov New 4872 81 0 Form and Instruction CMS-10766
CMS.gov User Satisfaction Survey New 10000 333 0 Form and Instruction CMS-10415
Clinician Focus Groups on Telehealth and Social Determinants of Health (CMS-10820) New 148 73 0 Form and Instruction CMS-10820
Form and Instruction CMS-10820
Electronic Medical Documentation Interoperability (EMDI) Workgroup Survey (CMS-10679) New 120 40 0 Form and Instruction CMS-10679
End Stage Renal Disease Grievant Satisfaction Survey New 384 77 0 Form and Instruction CMS-10415.GenIC #5
End Stage Renal Disease Quality Reporting System (EQRS) Customer Satisfaction and Task Prioritization Survey for the EQRS Release 1.0 Project (CMS-10626) New 200 50 0 Form and Instruction CMS-10626
Evaluation of Stakeholder Training - Health Insurance Marketplace and Market Stabilization Programs New 100000 417 0 Form and Instruction CMS-10415
IPRO Community of Care Coalitions Collaborator Survey (CMS-10771) New 50 8 0 Form and Instruction CMS-10771
IPRO Drug Safety Program Collaborator Survey (CMS-10770) New 16 3 0 Form and Instruction CMS-10770
IPRO ESRD Collaborator Satisfaction Survey (CMS-10750) New 560 93 0 Form and Instruction CMS-10750
Form and Instruction CMS-10750
Form and Instruction CMS-10750
Form and Instruction CMS-10750
MACBIS Software Application Electronic Surveys for Users (CMS-10719) New 2081 173 0 Form CMS-10719
MACBIS Software Application Electronic Surveys for Users (CMS-10719) New 2081 173 0 Form CMS-10719
Medicare Administrative Contractor (MAC) Customer Experience (MCE) Program – Audit and Reimbursement (CMS-10812) New 5000 250 0 Form CMS-10812
Form CMS-10812
Medicare Administrative Contractor (MAC) Customer Experience (MCE) Program – Provider Contact Center - Palmetto Web Chat Library of Questions (CMS-10813) New 1560 52 0 Form CMS-10813
Medicare Administrative Contractor (MAC) Customer Experience (MCE) Program – Provider Contact Center - Telephone Library of Questions (CMS-10815) New 60000 2000 0 Form CMS-10815
Medicare Administrative Contractor (MAC) Customer Experience (MCE) Program – Provider Contact Center - Written Correspondence Survey (CMS-10814) New 10000 500 0 Form CMS-10814
Medicare Administrative Contractor (MAC) Provider Customer Experience (CMS-10720) New 35000 1750 0 Form and Instruction CMS-10720
Form and Instruction CMS-10720
Form and Instruction CMS-10720
Form and Instruction CMS-10720
Medicare Administrative Contractor (MAC) Provider Experience Persistent Feedback (CMS-10721) New 45000 750 0 Form and Instruction CMS-10721
Form and Instruction CMS-10721
Form and Instruction CMS-10721
Form and Instruction CMS-10721
Medicare Casework Customer Satisfaction Survey (CMS-10746) New 5000 167 0 Form and Instruction CMS-10746
Medicare Part C & D Improper Payment Measure (IPM) (CMS-10811) New 900 45 0 Form and Instruction CMS-10811
Form and Instruction CMS-10811
Medicare.gov Sitewide Qualtrics (CMS-10676) New 100000 8333 0 Form and Instruction CMS-10676
Medicaregov - Medicare Plan Finder Survey New 25000 833 0 Form and Instruction CMS-10415
QualityNet.org and QualityNet Secure Portal Customer Satisfaction and Task Prioritization Survey for Phase 1 of the QualityNet Portal (QNP) redesign project (CMS- 10590) New 500 83 0 Form and Instruction CMS-10590
Replacing Durable Medical Equipment & Prescription Drugs after a Disaster: Addressing the Needs of Medicare Beneficiaries" post-training feedback survey (CMS-10828) New 60 10 0 Form and Instruction CMS-10828
Reporting for the Health Insurance Marketplace and Qualified Health Plan Enrollee Experience Surveys: Health Insurance Marketplace Consumer Experience Surveys (CMS-10534) New 90 106 0 Form and Instruction CMS-10534
Surveying our Customers – Post-activity Evaluation (CMS-10732) New 22320 1116 0 Form CMS-10732
Form CMS-10732
Form CMS-10732
Form CMS-10732
Form CMS-10732
Unmoderated Online User Testing of a Proposed New CMS.gov Website Structure (CMS-10682) New 50 13 0 Form CMS-10682
Usability Testing and Evaluation for Phase 1 of the QualityNet Portal (QNP) Redesign Project (CMS-10588) New 40 32 0 Form and Instruction CMS-10588
User Acceptance Testing for the Medicare Ground Ambulance Data Collection System (GADCS) (CMS-10754) New 80 160 0 Form and Instruction CMS-10754
Instruction
User Acceptance Testing for the Medicare Ground Ambulance Data Collection System (GADCS) (CMS-10754) New 60 120 0 Form and Instruction CMS-10754
Instruction
Form and Instruction CMS-10754
Total Burden Actually Used for Information Collections Under Currently Approved ICR: 687248 27570 0  
Total Burden Currently Requested for Information Collections Under Currently Approved ICR: 0 0 0  
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