Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Adult Qualified Health Plan Enrollee Experience Survey Modified 97505 48872 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
Form CMS-10488 Prenotification Letter - English
Form CMS-10488 Prenotification Letter (Spanish)
Form CMS_10488 Enrollee Survey Reminder Letter - Spanish
Total burden requested under this ICR: 97505 48872 0  
To view an IC, click on IC Title