NMEP Regional Survey of Medicare Beneficiaries

ICR 200112-0938-006

OMB: 0938-0859

Federal Form Document

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
8674 Migrated
ICR Details
0938-0859 200112-0938-006
Historical Active
HHS/CMS
NMEP Regional Survey of Medicare Beneficiaries
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 02/14/2002
Retrieve Notice of Action (NOA) 12/19/2001
  Inventory as of this Action Requested Previously Approved
02/28/2005 02/28/2005
20,000 0 0
5,000 0 0
0 0 0

CMS shall conduct a survey by selecting 2,000 Medicare beneficiaries per CMS region from CMS's administrative databases with oversampling for underserved populations, which include rural populations, ethnic populations, and disabled population as a part of the continuous assessment on the knowledge and understanding of the Medicare program and the NMEP/Medicare+Choice outreach and educational efforts to systematically quantify current knowledge and awareness and to assess future direction.

None
None


No

1
IC Title Form No. Form Name
NMEP Regional Survey of Medicare Beneficiaries CMS-10040

  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 20,000 0 0 20,000 0 0
Annual Time Burden (Hours) 5,000 0 0 5,000 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
No

$0
Yes Part B of Supporting Statement
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
12/19/2001


© 2024 OMB.report | Privacy Policy