Medicare Current Beneficiary 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
8167	Medicare Current Beneficiary Survey Form	Migrated

ICR Details

OMB Control No: 0938-0568	ICR Reference No: 199702-0938-004
Status: Historical Active	Previous ICR Reference No: 199606-0938-002
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Medicare Current Beneficiary Survey
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 02/21/1997
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/20/1997
	Date Received in OIRA: 02/20/1997
Terms of Clearance: Approved for use through 8/97 under the conditions that: 1) HCFA amend question OL 56 to determine beneficiary willingness to pay for the Medicare Handbook rather than how much HCFA should spend; 2) because OMB has concerns regarding the design of the focus group protocol, all future and pending focus groups must be based on a protocol developed in consultation with OMB. OMB expects that HCFA will use this new protocol and its implementation in new focus groups to revise this MCBS Supplement before it is fielded a second time; and 3) in its nested pretest of 200 respondents, HCFA administers the supple- ment without the core instrument to a subset of the pretest sample (i.e. a sample of the retiring respondents) to fully ascertain the impacts of the core instrument on the supplement.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/1997	08/31/1997	08/31/1999
Responses	16,000	0	1
Time Burden (Hours)	16,000	0	42,000
Cost Burden (Dollars)	0	0	0

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Abstract: A centerpiece of HCFA's mission is to provide clear and useful information to beneficiaries to assist them in making health care decisions. An integral part of the effort to fulfill this mission is asking beneficiaries to tell us what they need and how well we are responding to them. In keeping with this mission, HCFA is implementing a market research initiative that will collect and analyze data on the information needs and preferences of Medicare beneficiary populations. This data collection activity includes a supplement in the Medicare Current Beneficiary Survey for the market research initiative.

Emergency Justfication:

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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 Current Beneficiary Survey	HCFA-P-15A

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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	16,000	1	0	15,999	0	0
Annual Time Burden (Hours)	16,000	42,000	0	-26,000	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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

Burden Increase Due to:

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

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? Yes Part B of Supporting Statement

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: 02/20/1997

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