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

View Information Collection (IC)

CMS-10941.Medicare Provider Trust Feedback Survey
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10941 Yes Yes Fillable Fileable

Health Health Care Services

09-90-1901 HHS Correspondence, Customer Service, and Contact List Records  86 FR 12699

6,000 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   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 6,000 0 6,000 0 0 0
Annual IC Time Burden (Hours) 200 0 200 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
CMS-10941.Medicare Provider Trust Feedback Survey - Fast Track Submission 09/18/2025
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
Something went wrong when downloading this file. If you have any questions, please send an email to risc@gsa.gov.