Assessing the Division of Beneficiary Inquiry Service's Performance for Written Responses

ICR 200501-0938-008

OMB: 0938-0894

Federal Form Document

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Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
0938-0894 200501-0938-008
Historical Active 200303-0938-010
HHS/CMS
Assessing the Division of Beneficiary Inquiry Service's Performance for Written Responses
Extension without change of a currently approved collection   No
Regular
Approved with change 03/11/2005
Retrieve Notice of Action (NOA) 01/28/2005
  Inventory as of this Action Requested Previously Approved
03/31/2008 03/31/2008 03/31/2005
2,872 0 2,872
287 0 287
0 0 0

DBICS will collect information several times during FY'03 to assess the cutomer service provided via written responses. DBICS will conduct the written survey through mailings that will accompany actual responses. The envelopes will be sent by Release Clerks so that the actual writer has no knowledge that a particular response is being rated. The survey will be used to measure overall satisfaction of the customer service that the DBICS provides to Medicare beneficiaries and their representatives.

None
None


No

1
IC Title Form No. Form Name
Assessing the Division of Beneficiary Inquiry Service's Performance for Written Responses CMS-10068

  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 2,872 2,872 0 0 0 0
Annual Time Burden (Hours) 287 287 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
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.
01/28/2005


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