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Agenda
Reg Review
ICR
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
To view an IC, click on IC Title