Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Medicare Disenrollee Survey, Medicare Advantage (MA-PD and MA-Only) Modified 32045 6089 0 Form CMS-10316 MA PD Survey
Form CMS-10316 MA Only Survey
Form CMS-10316 MA Only_Spanish
Form CMS-10316 MAPD_Spanish
Form CMS-10316 MA-PD Survey_Traditional Chinese
Form CMS-10316 MA-Only Survey_Traditional Chinese
Form CMS-10316 MA-Only Survey_Vietnamese
Form CMS-10316 MA-PD Survey_Vietnamese
Medicare Disenrollee Survey, Stand Alone Prescription Drug Plan (PDP) Version Modified 4005 641 0 Form CMS-10316 Medicare Disenrollee Survey Prescriptopn Drug Plan
Form CMS-10316 Medicare Disenrollee Survey Prescriptopn Drug Plan (Spanish)
Form CMS-10316 Medicare Disenrollee Survey Prescriptopn Drug Plan (Chinese)
Form CMS-10316 Medicare Disenrollee Survey Prescriptopn Drug Plan (Vietnamese)
Total burden requested under this ICR: 36050 6730 0  
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