MSInteractive Survey Tool for www.medicare.gov

Forms and Documents

Document Name	Status
Form CMS-R-268 MSInteractive Survey Tool for www.medicare.gov Form and Instruction	Modified
Form CMS-R-268 MSInteractive Survey Tool for www.medicare.gov Form and Instruction	New
CMS-R-268.Supporting Statement-Part B-Final.doc Supporting Statement B	2008-03-17
CMS-R-268.Supporting Statement-Part A-Final.doc Supporting Statement A	2008-03-26

IC Document Collections

IC ID	Document Title	Status
8471	MSInteractive Survey Tool for www.medicare.gov Form and Instruction	Modified
184256	MSInteractive Survey Tool for www.medicare.gov Form and Instruction	New

ICR Details

OMB Control No: 0938-0756	ICR Reference No: 200803-0938-006
Status: Historical Active	Previous ICR Reference No: 200501-0938-001
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: MSInteractive Survey Tool for www.medicare.gov
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/12/2008
	Date Received in OIRA: 03/28/2008
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2011	36 Months From Approved	06/30/2008
Responses	7,000	0	7,000
Time Burden (Hours)	1,167	0	583
Cost Burden (Dollars)	0	0	0

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Abstract: The Department of Health and Human Services has developed a survey tool to obtain feedback from users accessing www.cms.hhs.gov and www.medicare.gov to guide future improvements. The purpose of this submission is to request a revision for 0938-0930 to continue to collect information from Internet users as they exit from the Websites Medicare.gov and CMS.hhs.gov. It is critical for this agency to obtain feedback from users of the Websites so that the agency can continually revise the sites to respond to the needs of its users.

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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:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 73830	12/28/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 13909	03/14/2008
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
MSInteractive Survey Tool for www.medicare.gov	CMS-R-268	MSInteractive Survey Tool for www.medicare.gov
MSInteractive Survey Tool for www.medicare.gov	CMS-R-268	MSInteractive Survey Tool for www.medicare.gov

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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	7,000	7,000	0	0	0	0
Annual Time Burden (Hours)	1,167	583	0	584	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: Miscellaneous Actions

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

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The allotted time used in the burden calcuation was increased from 5 minutes per individual to 10 minutes per individual.

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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: 03/28/2008

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