National Medicare Training Program Needs Assessment Survey

Forms and Documents

Document Name	Status
Form CMS-10257 National Medicare Training Program Needs Assessment Survey (State and Local Gov't) Form and Instruction	New
Form CMS-10257 National Medicare Training Program Needs Assessment Survey (Private Sector) Form and Instruction	New
Form CMS-10257 National Medicare Training Program Needs Assessment Survey (Federal government) Form and Instruction	New
CMS-10257.DRAFT email invitation_042109_.doc Supplementary Document	2009-05-05
CMS-10257.DRAFT email reminder_042109.doc Supplementary Document	2009-05-05
CMS-10257.Supporting Statement Part B.pdf Supporting Statement B	2008-08-26
Survey DRAFT email reminder_012408Fi _2_.pdf Supplementary Document	2008-08-26
Survey DRAFT email reminder_012408Fi _2_.pdf Supplementary Document	2008-08-26
Survey DRAFT email reminder_012408Fi _2_.pdf Supplementary Document	2008-08-26
Supporting Statement Part A_5-4-09.doc Supporting Statement A	2009-05-05

IC Document Collections

IC ID	Document Title	Status
186882	National Medicare Training Program Needs Assessment Survey (State and Local Gov't) Form and Instruction	New
186881	National Medicare Training Program Needs Assessment Survey (Private Sector) Form and Instruction	New
186880	National Medicare Training Program Needs Assessment Survey (Federal government) Form and Instruction	New

ICR Details

OMB Control No: 0938-1063	ICR Reference No: 200810-0938-010
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: National Medicare Training Program Needs Assessment Survey
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 05/29/2009
	Date Received in OIRA: 10/09/2008
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2012	36 Months From Approved
Responses	4,000	0	0
Time Burden (Hours)	1,000	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Centers for Medicare and Medicaid Services (CMS) is requesting clearance for an Online Needs Assessment Survey that will inform the National Medicare Training Program (NMTP) in their efforts to develop materials vital to the performance of key Medicare partners. NMTP communicates information about a wide array of Medicare topics to a diverse audience of partner organizations through in-person workshops,teleconferences, and Online training materials. These partner organizations include other state and federal agencies, health plans, aging networks/coalitions, long term care institutions, disability/mental health providers and advocates, HIV/AIDS providers, other health care providers and disease-specific advocacy groups, faith based organizations, and racial/ethnic minority organizations. These partners extend the reach of NMTP to population segments that have information barriers, including language, literacy, location, and culture, to help them understand the varied and sometimes complex choices about how they receive their Medicare benefits. This survey will allow NMTP to assess the education and training needs of its partner organizations on an annual basis, to ensure that they have the information and materials they need to assist the beneficiaries they serve.

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Authorizing Statute(s): PL: Pub.L. 105 - 33 . Name of Law: Balanced Budget Act of 1997
  

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:
	73 FR 24293	05/02/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 42578	07/22/2008
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
National Medicare Training Program Needs Assessment Survey (Federal government)	CMS-10257, CMS-10257	CMS-10257. Collection Instrument - Phone Version ,   CMS-10257. Collection Instrument - Web Version
National Medicare Training Program Needs Assessment Survey (Private Sector)	CMS-10257, CMS-10257	CMS-10257. Collection Instrument - Web Version ,   CMS-10257. Collection Instrument - Phone Version
National Medicare Training Program Needs Assessment Survey (State and Local Gov't)	CMS-10257, CMS-10257	CMS-10257. Collection Instrument - Phone Version ,   CMS-10257. Collection Instrument - Web Version

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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	4,000	0	0	4,000	0	0
Annual Time Burden (Hours)	1,000	0	0	1,000	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: No

Burden Reduction Due to:

Short Statement: This is a new collection.

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Annual Cost to Federal Government: $60,130

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)? No

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: 10/09/2008

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