MEDICARE BENEFICING SURVEY

Forms and Documents

Document Name	Status

No forms / supporting documents in this ICR. Check IC Document Collections.

IC Document Collections

IC ID	Document Title	Status
116748	MEDICARE BENEFICING SURVEY	Migrated

ICR Details

OMB Control No: 0990-0181	ICR Reference No: 198901-0990-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/HHSDM	Agency Tracking No:
Title: MEDICARE BENEFICING SURVEY
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/19/1989
	Date Received in OIRA: 01/19/1989
Terms of Clearance: Approved for use through 3/90 under the conditions that no data shall be collected until each of the following changes are made: 1) Questions regarding the beneficiary's perceived status of health, awareness of nursing home certification data, awareness of specific provisions of the Catastrophic Coverage Act, and active use of mortality data in selecting Medicare hospitals are added 2) Question 1 is deleted 3) Question 2a is deleted 4) Questions 5 and 7 are revised so they determine beneficiary awareness of payment policies in hospitals and home health care 5) Question 11 is revised so it addresses awareness of payment policies for long term care beyond 5 months 6)Questions 12-16 are revised so they reference the Medicare Handbook 7) Questions 31 and 32 are deleted 8) Question 37 is revised to read, "Did you or the doctor file a Medicare claim for the second doctor's opinion?" 9) Question 41 is revised to indicate where in the Handbook beneficiaries can find information regarding Medicare participating physicians 10) Question 52 is deleted and 11) Questions 54,55, and 56 are deleted. Prior to the initiation of data collection, the OIG must send OMB the finalized survey incorporating the above changes and displaying the OMB control number.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/1990	03/31/1990
Responses	640	0	0
Time Burden (Hours)	214	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: THIS REQUEST FOR INFORMATION ON BENEFICIARY EXPERIENCE WITH THE MEDICA PROGRAM IS NEEDED TO DETERMINE BENEFICIARIES' AWARENESS OF, USE OF, AN CONCERNS WITH VARIOUS ASPECTS OF THE MEDICARE PROGRAM. THE INFORMATIO WILL BE USED TO IDENTIFY POTENTIAL INEFFICIENCY WHICH NEEDS MORE DETAILED REVIEW AND CORRECTIVE ACTION.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
MEDICARE BENEFICING SURVEY

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	640	0	0	640	0	0
Annual Time Burden (Hours)	214	0	0	214	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 01/19/1989

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