Parts C and D Complaints Resolution Performance Measures

Forms and Documents

Document	Type	Status	Availability
Form CMS-10308 Parts C and D Complaints Resolution Performance Measures (CMS-10308)	Form and Instruction	New	Available
Cognitive Interview Memo_100324 ou_cb-1.doc	Supplementary Document	Uploaded 2010-09-16	Available
CR_OMB Supporting Statement B 100903 clean.pdf	Supporting Statement B	Uploaded 2010-09-15	Available
CR_OMB SummaryofRevisions 100520.pdf	Supplementary Document	Uploaded 2010-06-10	Available
CR_OMB 60-dayCommentSummary 100520.pdf	Supplementary Document	Uploaded 2010-06-10	Available
CR_OMB Explanations for Inclusion of Survey Qs 100520.pdf	Supplementary Document	Uploaded 2010-06-10	Available
CR_OMB Advance Letter 100520.pdf	Supplementary Document	Uploaded 2010-06-10	Available
CR_OMB Supporting Statement A 100903 clean.pdf	Supporting Statement A	Uploaded 2010-09-15	Available

IC Document Collections

IC ID	Collection	Type	Status	Form
193233	Parts C and D Complaints Resolution Performance Measures (CMS-10308)	Form and Instruction	New

ICR Details

OMB Control No: 0938-1107	ICR Reference No: 201006-0938-004
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Parts C and D Complaints Resolution Performance Measures
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: 09/21/2010
	Date Received in OIRA: 06/11/2010
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2013	36 Months From Approved
Responses	5,300	0	0
Time Burden (Hours)	884	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: The Complaints Resolution project will assist CMS in developing and supporting implementation of a plan performance measure that represents plan resolution of beneficiary complaints from the perspective of the beneficiaries themselves. Thus, the project includes development of methodologies for: 1.) identifying a statistically valid sample of beneficiary complaints needed to analyze the complaint's closure; 2.) contacting, interviewing, and summarizing beneficiary experience; and, 3.) summarizing/analyzing the resultant data to assess veracity of the resolution of beneficiary complaints from the perspective of the beneficiaries themselves via objective exploration of the beneficiary's complaint resolution experience.

---

Authorizing Statute(s): EO: EO 13410 Name/Subject of EO: Promoting Quality and Efficient Health Care in Federal Government Administered
  

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:
	75 FR 8722	02/25/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 31789	06/04/2010
Did the Agency receive public comments on this ICR? Yes

---

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

IC Title	Form No.	Form Name
Parts C and D Complaints Resolution Performance Measures (CMS-10308)	CMS-10308	Parts C and D Complaint Closure Beneficiary Survey

---

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	5,300	0	0	5,300	0	0
Annual Time Burden (Hours)	884	0	0	884	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: The increase in burden occurred because of a Miscellaneous Action due to Agency Discretion. Specifically, CMS is conducting a new information collection to support the development and implementation of a performance measure for the Medicare Advantage (Part C) and Prescription Drug (Part D) program that represents plan resolution of beneficiary complaints from the beneficiary perspective. The proposed information collection is necessary because a survey is the only way to collect information about the complaints resolution process from the beneficiary perspective. Currently, there is no other data source that collects such information for Part C and Part D Medicare plans.

---

Annual Cost to Federal Government: $522,623

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]? No

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

---

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: 06/11/2010

---