View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	MACBIS Software Application Electronic Surveys for Users (CMS-10719)	Agency IC Tracking Number:	CMCS

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-10719	MACBIS Software Application Electronic Survey	Webinar Survey_Polling Questions.xlsx		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,775	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	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	2,081	0	2,081	0	0	0
Annual IC Time Burden (Hours)	173	0	173	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Fast Track Supporting Statement	CMS-10719 - Fast Track Supporting Statement - Nov 2020 udpate v2 CLEAN.docx	12/28/2020

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.