View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Medicare Administrative Contractor (MAC) Customer Experience (MCE) Program – Provider Contact Center - Written Correspondence Survey (CMS-10814)	Agency IC Tracking Number:

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-10814	CMS-10814. Written Correspondence Instrument	CMS-10814. Written Correspondence Instrument.docx		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: 10,000	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

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	10,000	0	10,000	0	0	0
Annual IC Time Burden (Hours)	500	0	500	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
CMS-10814.Written Correspondence Fast Track Form	CMS-10814.Written Correspondence Fast Track Form.docx	06/21/2022
CMS-10814. Link for PRA Disclosure Statement	CMS-10814. Link for PRA Disclosure Statement.pdf	06/21/2022

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