View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Account Manager Satisfaction Survey (CMS-10748)	Agency IC Tracking Number:	OPOLE

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-10748	Account Manager Satisfaction Survey	2- Survey Questionsrevised.docx		Yes	Yes	Fillable Printable

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: 300	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

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	300	0	300	0	0	0
Annual IC Time Burden (Hours)	5	0	5	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Crosswalk	Crosswalk of changes.xlsx	03/04/2021
Fast Track Supporting Statement	CMS-10748 - Fast Track Supporting Statement (2020 version 3).docx	03/04/2021
Justification for Nonsubstantive Change	Justification for Nonsubstantive Change.docx	03/04/2021

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