View Information Collection (IC)

View Information Collection (IC)

IC Title:	Customer Effort Scoring - Surveys (CMS-10833)	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-10833	QualityNet-EQRS Help Desk Customer Feedback Survey	CMS-10833 2020 EQRS Cust Effort Q.draft.2-final.docx		Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10833	QualityNet Help Desk Customer Feedback Survey	CMS-10833 2020 QNET Cust Effort Q.draft.2-final.docx		Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10833	QPP Customer Effort Questionnaire: 2020 Online Survey	CMS-10833 2020 QPP Cust Effort Q.OnlineSurvey.draft.01.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: 4,800	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	4,800	0	4,800	0	0	0
Annual IC Time Burden (Hours)	400	0	400	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement	CMS-10833 Customer Effort Scoring ICR.docx	10/03/2022

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