Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
(REVISED) CMS-10710. GenIC#15 – TRIPTK- Journey AI Survey - Medical Professionals Modified 300 1 0 Form and Instruction CMS-10710.GenIC#15
CMS-10710. GenIC #9 - Notice Testing: CMS Notice of Denial of Part D Drug Coverage (CMS-10146) Modified 24 24 0 Form and Instruction CMS-10146
Form and Instruction CMS-10146
CMS-10710. GenIC#13 - TRIPTK Modified 132 192 0 Form and Instruction CMS-10710
Form and Instruction CMS-10710
Form and Instruction CMS-10710
Form and Instruction CMS-10710
Form and Instruction CMS-10710
Form and Instruction CMS-10710
CMS-10710. GenIC#15 – TRIPTK- Journey AI Survey - Professionals Modified 300 100 0 Form and Instruction CMS-10710
CMS-10710.GenIC #6 - Marketplace IVR Customer Sat Survey (A11 Section 280) Modified 300000 25000 0 Form and Instruction CMS-10710.GenIC#6
CMS-10710.GenIC#10.- Notice Testing: CMS Notice of Denial of Medical Coverage (CMS-10003) Modified 24 24 0 Form and Instruction CMS-10003
Form and Instruction CMS-10003
CMS-10710.GenIC#4 - Healthcare.gov Web Satisfaction Survey (A11 Section 280) Modified 24000 1600 0 Form and Instruction CMS-10710.GenIC#4
CMS-10710.GenIC#4 - Healthcare.gov Web Satisfaction Survey (REVISON) Modified 24000 2 0 Form and Instruction CMS-10710.GenIC#4 (REVISION)
CMS-10710.GenIC#5 - Medicare.gov Web Sat Survey (A11 Section 280) Modified 360000 24000 0 Form and Instruction CMS-10710.GenIC#5
CMS-10710.GenIC#7 - Medicare IVR Customer Sat Survey (A11 Section 280) (30-day) Modified 1000000 83333 0 Form and Instruction CMS-10710.GenIc#7
CMS-10710.GenIC#8 - High Impact Trust Survey Medicare Modified 10000 500 0 Form and Instruction CMS-10710.GenIC #8
Facing Financial Shock Applicant Recruitment Survey (CMS-10900) Modified 1200 200 0 Form and Instruction CMS-10900
Foundational Generative In-Depth Interviews for Identifying Needs and Challenges of Adult Caregivers' on Issues Related to Access, Technology, Privacy and Data sharing (CMS-10903) Modified 1220 220 0 Form and Instruction CMS-10903
Form and Instruction CMS-10903
Form and Instruction CMS-10903
GenIC #11 - Notice Testing: CMS Notice of Change of Status (CMS-10868) Modified 24 24 0 Form and Instruction CMS-10710.GenIC#11
GenIC #12 – Usability and Cognitive Testing: HC.gov Application Enhancements for DACA Recipients Modified 48 48 0 Form and Instruction CMS-10710#12
GenIC#14 – TRIPTK- Journey AI Surveys Beneficiaries and Caregivers Modified 1100 366 0 Form and Instruction CMS-10710.GenIC#14
Medicare Advantage Beneficiary Customer Satisfaction Survey for Complaint Resolution (CMS-10970) Modified 5000 167 0 Form and Instruction CMS-10970
Salesforce Customer Relationship Management Satisfaction Survey (CMS-10966) Modified 10000 500 0 Form and Instruction CMS-10966
Website Page Feedback Form: Find Local Help on https://www.healthcare.gov (CMS-10962) Modified 550 18 0 Form and Instruction CMS_10962
Form and Instruction CMS-10962
[Medicaid] CMS-10909 (Revision): Medicaid.gov Pop-up Survey Modified 1 0 0 Form and Instruction CMS-10909
[Medicaid] CMS-10910 (Revision): Insure Kids Now Pop-up Survey Modified 1 0 0 Form and Instruction CMS-10910
[Medicaid] CMS-10911 (Revision): Medicaid.gov Static Feedback Modified 1 0 0 Form and Instruction CMS-10911
[Medicaid] Insure Kids Now Customer Feedback Survey (CMS-10910) Modified 100 3 0 Form and Instruction CMS-10910
[Medicaid] Medicaid.gov Customer Feedback Survey (CMS-10909) Modified 2643 88 0 Form and Instruction CMS-10909
[Medicaid] Medicaid.gov Feedback Survey (CMS-10911) Modified 1300 22 0 Form and Instruction CMS-10911
Form CMS-10911
Total burden requested under this ICR: 1741968 136432 0  
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