View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

Surveying our Customers – Post-activity Evaluation (CMS-10732) OPOLE
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-10732 Customer and Stakeholder Feedback: Providers/Suppliers LEA Engagement Eval Prov.Supp (version 3).docx No   Fillable Fileable
Form CMS-10732 Customer and Stakeholder Feedback: Medicare Beneficiary LEA Engagement Eval Medicare Bene (version 3).docx No   Fillable Fileable
Form CMS-10732 Customer and Stakeholder Feedback: Marketplace Consumer LEA Engagement Eval Marketplace Consumer (version 3).docx No   Fillable Fileable
Form CMS-10732 Customer and Stakeholder Feedback: SHIP or Other Assister or Partner LEA Engagement Eval SHIP or Other (version 3).docx No   Fillable Fileable
Form CMS-10732 Customer and Stakeholder Feedback: All (Webinar) LEA Engagement Eval from Webinar Hyperlink (version 3).docx Yes Yes Fillable Fileable

Health Health Care Services

 

22,320 0
   
Individuals or Households
 
   50 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 22,320 0 22,320 0 0 0
Annual IC Time Burden (Hours) 1,116 0 1,116 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Fast Track Supporting Statement CMS-10732 - LEA Fast Track Supporting Statement (version 3).docx 07/09/2020
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.