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

View Information Collection (IC)

Potential Refinements to the Qualified Health Plan Enrollee Experience Survey (QHP Enrollee Survey): Focus Groups with Consumers and QHP Issuers (CMS-10869)
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10869 Attachment A - Recruitment Screeners for Consumer and Issuer Focus Groups CMS-10869 - AttachA-CnsmrIssFGRcrtmntScrnr-508.pdf No   Paper Only
Form and Instruction CMS-10869 Attachment B: Consent Forms for Consumers and Issuers CMS-10869 - AttachB-CnsmIssFG-CnsntForms-508.pdf No   Paper Only
Form and Instruction CMS-10869 Attachment C: CMS QHP Enrollee Survey Consumer Focus Group Protocol CMS-10869 - AttachC-CnsmrFGPrtcl-508.pdf No   Paper Only
Form and Instruction CMS-10869 Attachment D: CMS QHP Enrollee Survey QHP Issuer Focus Group Protocol CMS-10869 - AttachD-IssFGPrtcl-508.pdf No   Paper Only

Health Health Care Services

 

40 0
   
Individuals or Households
 
   0 %

  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 40 0 40 0 0 0
Annual IC Time Burden (Hours) 9 0 9 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
CMS-10869. QHP-ES-2023-FGG-PRA-Fast Track Submission CMS-10869. QHP-ES-2023-FGG-PRA-Fast Track Submission .docx 08/01/2023
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.