Medicare Advantage (MA) Survey

Medicare Advantage, Medicare Part D, and Medicare Fee-For-Service Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey (CMS-R-246)

Documents and Forms

Document Name Document Type
Form CMS-R-246 Medicare Advantage (MA) Survey Form and Instruction
CMS-R-246 Medicare Advantage Plan Survey 2026-MA-Only-Survey_clean .docx Form and Instruction
CMS-R-246 Medicare Advantage Plan Survey - Chinese 2025-MA-Only-Survey-Chinese.pdf Form and Instruction
CMS-R-246 Medicare Advantage Plan Survey - Korean 2025-MA-Only-Survey-Korean.pdf Form and Instruction
CMS-R-246 Medicare Advantage Plan Survey - Spanish 2025-MA-Only-Survey-Spanish.pdf Form and Instruction
CMS-R-246 Medicare Advantage Plan Survey - Tagalog 2025-MA-Only-Survey-Tagalog.pdf Form and Instruction
CMS-R-246 Medicare Advantage Plan Survey - Vietnamese 2025-MA-Only-Survey-Vietnamese.pdf Form and Instruction
2026-MA-Only-Survey_redline.pdf Track Change version IC Document

Information Collection (IC) Details

IC Title:	Medicare Advantage (MA) Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 417.472 42 CFR 422.152 42 CFR 422.156

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form and Instruction	CMS-R-246	Medicare Advantage Plan Survey	2026-MA-Only-Survey_clean .docx	No	Fillable Printable
Form and Instruction	CMS-R-246	Medicare Advantage Plan Survey - Chinese	2025-MA-Only-Survey-Chinese.pdf	No	Fillable Printable
Form and Instruction	CMS-R-246	Medicare Advantage Plan Survey - Korean	2025-MA-Only-Survey-Korean.pdf	No	Fillable Printable
Form and Instruction	CMS-R-246	Medicare Advantage Plan Survey - Spanish	2025-MA-Only-Survey-Spanish.pdf	No	Fillable Printable
Form and Instruction	CMS-R-246	Medicare Advantage Plan Survey - Tagalog	2025-MA-Only-Survey-Tagalog.pdf	No	Fillable Printable
Form and Instruction	CMS-R-246	Medicare Advantage Plan Survey - Vietnamese	2025-MA-Only-Survey-Vietnamese.pdf	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: Privacy Act of 1974: HPMS # 09-70-4004	FR Citation: 63 FR 43187

Number of Respondents: 440,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	440,000	440,000
Annual IC Time Burden (Hours)	110,000	110,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Track Change version	2026-MA-Only-Survey_redline.pdf	06/05/2025

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