Information Collection

GenIC#3 - Medicare Open Enrollment Survey

IC 218112 under ICR 201307-0938-017 · OMB 0938-1247.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1247 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10437 GenIC#3 - Medicare Open Enrollment Survey Form and Instruction
CMS-10437 Pre Campaign Survey CMS-10437.GenIC #3 -OMB OE PRE CAMPAIGN SURVEY.docx Form and Instruction
CMS-10437 Post Campaign Survey CMS-10437.GenIC #3 - OMB OE POSTCAMPAIGN SURVEY.docx Form and Instruction
CMS-10437.GenIC#3 - Mini Supporting Statement.docx CMS-10437.GenIC#3 - Mini Supporting Statement IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	GenIC#3 - Medicare Open Enrollment Survey	Agency IC Tracking Number:

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-10437	Pre Campaign Survey	CMS-10437.GenIC #3 -OMB OE PRE CAMPAIGN SURVEY.docx		Yes	No	Fillable Fileable
Form and Instruction	CMS-10437	Post Campaign Survey	CMS-10437.GenIC #3 - OMB OE POSTCAMPAIGN SURVEY.docx		Yes	No	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,000	2,000
Annual IC Time Burden (Hours)	400	400
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
CMS-10437.GenIC#3 - Mini Supporting Statement	CMS-10437.GenIC#3 - Mini Supporting Statement.docx	09/08/2015

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