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Federal forms, ICRs, and supporting documents

Information Collection

Medicare Beneficiary and Family-Centered Satisfaction Survey

IC 201543 under ICR 202310-0938-005 · OMB 0938-1177.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Medicare Beneficiary and Family-Centered Satisfaction Survey
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10393 Attachment B: Beneficiary Experience Survey CMS-10393_Attachment B_Experience Survey_06.29.2023.docx Yes Yes Fillable Fileable

Health Health Care Services

 

9,000 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 9,000 0 300 0 0 8,700
Annual IC Time Burden (Hours) 2,250 0 75 0 0 2,175
Annual IC Cost Burden (Dollars) 31,365 0 1,045 0 0 30,320

Title Document Date Uploaded
Legislation CMS-10393_Attachment A_Related Legislation_06.29.2023_508.pdf 10/27/2023
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.