OMB control number
Medicare Plan Performance Warning Information (CMS-10836)
OMB 0938-1456 · HHS/CMS.
The Centers for Medicare & Medicaid Services (CMS) is seeking approval to collect information to assist in the Agency’s response to two reports from the Department of Health and Human Services Office of the Inspector General (OIG) related to how the agency conveys information on plan performance. CMS is conducting this research to respond to OIG’s recommendations related to sharing clear and accessible information with beneficiaries on plan performance, particularly related to information which may warn or caution beneficiaries about plan performance issues. CMS is seeking to learn more about how beneficiaries, caregivers, and the intermediaries who assist them use and understand the information CMS currently makes (or may make) available, as well as to assess their interest in accessing this information.
The latest form for Medicare Plan Performance Warning Information (CMS-10836) expires 2026-12-31 and can be found here.
Document Name |
|---|
Form and Instruction |
Form and Instruction |
Supporting Statement A |
Form CMS-10836 IDI Discussion Guide
CMS-10836 -Supporting Statement A -.docx
IDI Discussion Guide |
Approved with change |
New collection (Request for a new OMB Control Number) | 2023-03-15 |
Scheduling/Screening
Federal Enterprise Architecture: Health - Health Care Services
| Form CMS-10836 | Interview Screener: Typical and Engaged Beneficiaries | Fillable Fileable | Form and instruction |
| Form CMS-10836 | Interview Screener: Typical Beneficiaries: Caregivers | Fillable Fileable | Form and instruction |
Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.