View Information Collection (IC)

View Information Collection (IC)

IC Title:	Center for Clinical Standards and Quality (CCSQ) Support Central Customer Satisfaction Survey (CMS-10818)	Agency IC Tracking Number:	CCSQ

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 and Instruction	CMS-10818	Call Scheduling	CMS-10818 Call Scheduling - CCSQ Suppot Central Survey Mock-ups.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10818	Create a Ticket	CMS-10818 Create A Ticket - CCSQ Support Central Survey Mock-ups.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10818	Live Chat	CMS-10818 Live Chat - CCSQ Support Central Survey Mock-ups.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10818	Track Existing Ticket	CMS-10818 Track Existing Ticket - CCSQ Support Central Survey Mock-ups.pdf		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: 2,800	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	2,800	0	2,800	0	0	0
Annual IC Time Burden (Hours)	93	0	93	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
CMS-10818 Supporting Statement	CMS-10818 CCSQ Support Central Surveys Supporting Statement.docx	07/22/2022

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