Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Adult Qualified Health Plan Enrollee Experience Survey Modified 82500 49550 0 Form and Instruction CMS-10488 Survey Vendor Application
Form and Instruction CMS-10488 QHP Survey (Chinese)
Form CMS-10488 Cover Letter (Chinese)
Form and Instruction CMS-10488 QHP Survey (English)
Form CMS-10488 Cover Letter 1 (English)
Form and Instruction CMS-10488 QHP Survey (Spanish)
Form and Instruction CMS-10488 Cover Letter (Spanish)
Form and Instruction CMS-10488 Chinese Cover Letter - 2
Form CMS-10488 Chinese Prenotification Letter
Form CMS-10488 Chinese Reminder Letter
Form and Instruction CMS-10488 English Cover Letter 2
Form and Instruction CMS-10488 English Cover Letter 2
Total burden requested under this ICR: 82500 49550 0  
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