Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
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
User Acceptance Testing for the Medicare Ground Ambulance Data Collection System (GADCS) (CMS-10754) New 80 160 0 Form and Instruction CMS-10754
Instruction
12th SOW Patient Activation Assessment (CMS-10723) New 100000 3333 0 Form and Instruction CMS-10723
Account Manager Satisfaction Survey (CMS-10748) New 300 50 0 Form CMS-10748
Account Manager Satisfaction Survey (CMS-10748) New 425 71 0 Form CMS-10748
Form CMS-10748
Form CMS-10748
Other-Other-Emails to Plan Sponsors
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.gov User Satisfaction Survey New 10000 333 0 Form and Instruction CMS-10415
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
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-10827
Form and Instruction CMS-10827
Form and Instruction CMS-10827
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.gov Medicare Plan Finder Survey New 25000 833 0 Form and Instruction CMS-10415
Medicare.gov Sitewide Qualtrics (CMS-10676) New 100000 8333 0 Form and Instruction CMS-10676
Oral Health Illustration Survey (CMS-10864) New 100 17 0 Form and Instruction CMS-10864
Other-Illustrations
Patient Subject Matter Expert (PSME) Satisfaction Survey (CMS-10859) New 198698 6557 0 Form and Instruction CMS-10859
Post Conference Event Feedback Request (CMS-10879) New 2000 83 0 Form and Instruction CMS-10879
Post-Acute Care Training Project (10873) New 3000 100 0 Form and Instruction CMS-10873
Quality Improvement of IPPTA Processes and Procedures (CMS-10894) 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
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 and Instruction CMS-10732
Form CMS-10732
Form CMS-10732
Form CMS-10732
Form CMS-10732
User Acceptance Testing for the Medicare Ground Ambulance Data Collection System (GADCS) - Observed Testing (CMS-10754) New 60 120 0 Form and Instruction CMS-10754
Instruction
Form and Instruction CMS-10754
Total burden requested under this ICR: 907028 38387 0  
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