Medicare CAHPS Survey

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-R-246 The Medicare Managed Care CAHPS Survey : CMS-R-246	Form and Instruction	Modified	Repair queued
Supporting Statement B.doc	Supporting Statement B	Uploaded 2007-06-12	Repair queued
CMS-R-246 FFS PDP CAHPS OMB FULL PACKAGE 3 8 2007.doc	Supporting Statement A	Uploaded 2007-06-13	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
8404	The Medicare Managed Care CAHPS Survey : CMS-R-246	Form and Instruction	Modified

ICR Details

OMB Control No: 0938-0732	ICR Reference No: 200706-0938-005
Status: Historical Active	Previous ICR Reference No: 200611-0938-012
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Medicare CAHPS Survey
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/02/2007
	Date Received in OIRA: 06/19/2007
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2010	36 Months From Approved	11/30/2007
Responses	660,000	0	600,000
Time Burden (Hours)	217,800	0	198,000
Cost Burden (Dollars)	0	0	0

---

Abstract: Currently, CMS is fielding the 2006 set of questions in the Medicare CAHPS (OMB No. 0935-0124) to be completed October 2007. The 2006 Medicare CAHPS survey is a shortened version of the Medicare Advantage (MA) and Medicare fee-for-service (MFFS) CAHPS surveys with addition of questions on the experiences of persons enrolled in a Medicare prescription drug plan. This shortened survey will be continued annually and will permit aggregation of the data and presentation of CAHPS measures at levels representing MA and MA-PD plans, as well as stand-alone PDPs, and the original Medicare FFS health plan.

---

Authorizing Statute(s): PL: Pub.L. 108 - 173 1860D Name of Law: Information to Facilitate Enrollment
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 13793	03/23/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 31840	06/08/2007
Did the Agency receive public comments on this ICR? No

---

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

table that charts list of burden

IC Title	Form No.	Form Name
The Medicare Managed Care CAHPS Survey : CMS-R-246	CMS-R-246	Medicare MA, FFS and PDP Surveys

---

ICR Summary of Burden

table that charts list 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	660,000	600,000	0	0	60,000	0
Annual Time Burden (Hours)	217,800	198,000	0	0	19,800	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: No

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government: $8,700,000

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

---

Common Form ICR:  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:

(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: 06/19/2007

---