Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
13th Statement of Work (SoW) Quality Improvement Network-Quality Improvement Organization (QIN-QIO) and American Indian/Alaska Native (AIAN-QIO) Provider Experience Encounter Survey (CMS-10919) New 26003 7534 0 Form and Instruction CMS-10919
Form and Instruction CMS-10919
CCSQ Service Center Customer Experience Incident Survey (CMS-10938) New 150 8 0 Form and Instruction CMS-10938
CCSQ Support Central Knowledge/Resource Center Survey (CMS-10886) New 2000 167 0 Form and Instruction CMS-10886
CCSQ Support Central Live Chat and Virtual Agent Enhancement Survey (CMS-10896) New 2000 167 0 Form and Instruction CMS-10896
CCSQ Support Central Post-Webinar Customer Feedback Survey (CMS-10922) New 90 3 0 Form and Instruction CMS-10922
Center for Clinical Standards and Quality (CCSQ) Support Central Customer Satisfaction Survey (CMS-10818) New 2800 93 0 Form and Instruction CMS-10818
Form and Instruction CMS-10818
Form and Instruction CMS-10818
Form and Instruction CMS-10818
Chat/CCSQ Support Central – Basic information questions (CMS-10832) New 10155 508 0 Form and Instruction CMS-10832
Contact Quality, Safety and Education Portal (QSEP) Help Desk (CMS-10937) New 1007 37 0 Form and Instruction CMS-10937
Customer Effort Scoring - Surveys (CMS-10833) New 4800 400 0 Form and Instruction CMS-10833
Form and Instruction CMS-10833
Form and Instruction CMS-10833
Customer Experience Surveys (CMS-10833 revised) New 4800 400 0 Form and Instruction CMS-10833
Electronic Prescribing of Controlled Substances (EPCS) - Education & Outreach (E&O) Document Survey (CMS-10939) New 100 10 0 Form and Instruction CMS-10939
Electronic Prescribing of Controlled Substances (EPCS) Webinar Survey (CMS-10940) New 100 10 0 Form and Instruction CMS-10940
End Stage Renal Disease Quality Reporting System EQRS (EQRS) Idea Portal. (CMS-10920 New 1000 83 0 Form and Instruction CMS-10920
Hospital Quality Reporting Communications Survey (CMS-10928) New 300 60 0 Form and Instruction CMS-10928
Hospital Quality Reporting User Language Card Sort (CMS-10871) New 75 18 0 Form and Instruction CMS-10871
Hospital Quality Reporting User Research Participation Interest Survey (CMS-10817 revised) New 2000 67 0 Form and Instruction CMS-10817
Idea Portal for User Insights on CMS Quality Improvement Organization Platform (CQP) (CMS-10927) New 1000 33 0 Form and Instruction CMS-10927
Idea Portal for User Insights on Hospital Quality Reporting (CMS-10904) New 2000 67 0 Form and Instruction CMS-10904
Internet Quality Improvement and Evaluation System (IQIES) Idea Portal (CMS-10810) New 1000 83 0 Form and Instruction CMS-10810
Internet Quality Improvement and Evaluation System (iQIES) HCD User Research Form (CMS-10808) New 2000 167 0 Form and Instruction CMS-10808
Medicare.gov Doctors and Clinicians Webpage Improvement – Interest Form (CMS-10936) New 1068 97 0 Form and Instruction CMS-10936
Form and Instruction CMS-10936
Form and Instruction CMS-10936
Form and Instruction CMS-10936
Form and Instruction CMS-10936
Form and Instruction CMS-10936
QPP Submissions Intercept Survey (CMS-10838) New 1500 125 0 Form and Instruction CMS-10838
QPP Submissions Intercept Survey (CMS-10838) New 1500 125 0 Form and Instruction CMS-10838
Quality Payment Program Site Intercept Survey (CMS-10804) New 1200 100 0 Form and Instruction CMS-10804
Single Ease Question for User Insights on Hospital Quality Reporting (CMS-10800 revised) New 2000 6 0 Form and Instruction CMS-10800
System Usability Scale Survey for MADiE (CMS-10929) New 60 10 0 Form and Instruction CMS-10929
Transplant Center Data Exchange Capabilities Survey (CMS-10907) New 225 75 0 Form and Instruction CMS-10907
iQIES Post-Launch Sentiment Survey (CMS-10926) New 200 7 0 Form CMS-10926
Instruction
Total Burden Actually Used for Information Collections Under Currently Approved ICR: 71133 10460 0  
Total Burden Currently Requested for Information Collections Under Currently Approved ICR: 0 0 0  
To view an IC, click on IC Title