Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
(CMS-10879) Post Conference Event Feedback Request New 2000 83 0 Form and Instruction CMS-10879
12th SOW Patient Activation Assessment (CMS-10723) New 100000 3333 0 Form and Instruction CMS-10723
2023 IPRO ESRD Collaborator Satisfaction Survey (CMS-10750) New 1453 245 0 Form and Instruction CMS-10750
Form and Instruction CMS-10750
Form and Instruction CMS-10750
Form and Instruction CMS-10750
Account Manager Satisfaction Survey (CMS-10748) New 425 71 0 Form CMS-10748
Form CMS-10748
Form CMS-10748
Other-Emails to Plan Sponsors
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
Blue Button 2.0 Developer Experience Customer Satisfaction Survey. (CMS-10924) New 220 77 0 Form and Instruction CMS-10924
CCW VRDC Stakeholder Engagement Plan (CMS-10880) New 1620 615 0 Form and Instruction CMS-10880
Form and Instruction CMS-10880
CMS-10811. Medicare Parts C and D Improper Payment Measure (IPM) (REVISON) New 900 45 0 Form and Instruction CMS-10811
Form and Instruction CMS-10811
CMS.gov User Satisfaction Survey New 10000 333 0 Form and Instruction CMS-10415
COVID-19 Campaign Survey on Fee-for-Service CMS.gov (CMS-10766) New 4872 81 0 Form and Instruction CMS-10766
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
Data Collection for Education and Outreach for the Yello System (CMS-10872) New 284000 9488 0 Form and Instruction CMS-10872
Emergency Medical Treatment and Labor Act (EMTALA) Complaint Form (CMS-10892) New 600 50 0 Form and Instruction CMS-10892
End Stage Renal Disease Grievant Satisfaction Survey New 384 77 0 Form and Instruction CMS-10415. GenIC#5
Foundational Generative In-Depth Interviews for Medicare Enrollees Seeking Their Medicare Claims Data (CMS-10903) New 1220 222 0 Form and Instruction CMS-10903
Form and Instruction CMS-10903.Attachment B
Form and Instruction CMS-10903
Health Care Consumer Feedback on Open Payments National Transparency Program (Open Payments) (CMS-10827) New 360 200 0 Form and Instruction CMS-10827
Form and Instruction CMS-10826
Form and Instruction CMS-10826
Form and Instruction CMS-10826
Health Care Provider Feedback on Open Payments National Transparency Program (Open Payments) - (CMS-10826) New 138 44 0 Form and Instruction CMS-10826
Form and Instruction CMS-10826
Form and Instruction CMS-10826
Form and Instruction CMS-10826
Health Equity Conference Satisfaction Survey and Interviews (CMS-10890) New 2500 208 0 Form and Instruction CMS-10890
IPRO Collaborator Satisfaction Survey-Request for Approval-Nursing Homes (CMS-10776) New 964 161 0 Form and Instruction CMS-10776
IPRO Community of Care Coalitions Collaborator Survey (2023)(CMS-10771) New 9 2 0 Form and Instruction CMS-10771
IPRO Community of Care Coalitions Collaborator Survey (CMS-10771) New 50 8 0 Form and Instruction CMS-10771
IPRO Drug Safety Program Collaborator Survey (2023) (CMS-10770) New 4 1 0 Form and Instruction CMS-10770
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
IPRO Nursing Home Collaborator Satisfaction Survey (2023) (CMS-10776) New 200 33 0 Form and Instruction CMS-10776
J.9 Network Satisfaction Survey (CMS-10841) New 7794 257 0 Form and Instruction CMS-10841
MACBIS Software Application Electronic Surveys for Users (CMS-10719) New 2081 173 0 Form CMS-10719
MACBIS Software Application Electronic Surveys for Users - Webinar Survey Polling Questions (CMS-10719) New 2081 173 0 Form CMS-10719
Medicare Administrative Contactors Customer Experience – Medical Review (CMS-10763) New 3000 150 0 Form and Instruction CMS-10763
Form and Instruction CMS-10763
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 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 Customer Experience – Mobile Application (CMS-10761) New 500 25 0 Form and Instruction CMS-10761
Form and Instruction CMS-10761
Medicare Administrative Contractor (MAC) Provider Experience Persistent Feedback – Mobile Application (CMS-10762) New 500 8 0 Form and Instruction CMS-10762
Form and Instruction CMS-10762
Medicare Casework Customer Satisfaction Survey (CMS-10746) New 5000 167 0 Form and Instruction CMS-10746
Medicare Fee-for-Service Provider Communications Preferences Survey (CMS-10876) New 2550 638 0 Form and Instruction CMS-10876
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 Survey (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
Oral Health Illustration Survey (CMS-10864) New 100 17 0 Other-Illustrations
Form and Instruction CMS-10864
Overall Flu Campaign Feedback Survey (CMS-10760) New 4872 81 0 Form and Instruction CMS-10760
Patient Subject Matter Expert (PSME) Satisfaction Survey (CMS-10859) New 198698 6557 0 Form and Instruction CMS-10859
Post-Acute Care Training Project (10873) New 3000 100 0 Form and Instruction CMS-10873
Potential Refinements to the Qualified Health Plan Enrollee Experience Survey (QHP Enrollee Survey): Cognitive Testing New 50 50 0 Form CMS-10889
Form CMS-10889
Form CMS-10889
Form CMS-10889
Potential Refinements to the Qualified Health Plan Enrollee Experience Survey (QHP Enrollee Survey): Focus Groups with Consumers and QHP Issuers (CMS-10869) New 40 9 0 Form and Instruction CMS-10869
Form and Instruction CMS-10869
Form and Instruction CMS-10869
Form and Instruction CMS-10869
Quality Improvement of IPPTA Processes and Procedures New 19 228 0 Form and Instruction CMS-10894
Form and Instruction CMS-10894
Form and Instruction CMS-10894
Form and Instruction CMS-10894
Form and Instruction CMS-10894
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 and 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
Survey Refinement for the Qualified Health Plan Enrollee Experience Survey (CMS-10726) New 40 90 0 Form and Instruction CMS-10726
Form and Instruction CMS-10726
Form and Instruction CMS10726
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
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: 1094738 46197 0  
Total Burden Currently Requested for Information Collections Under Currently Approved ICR: 0 0 0  
To view an IC, click on IC Title