State Health Insurance Assistance Program (SHIP) Client Contact Form, Pubic and Media Activity Form, and Resource Report Form
Revision of a currently approved collection
No
Regular
Approved without change
07/16/2010
06/15/2010
table that charts list comparision
Inventory as of this Action
Requested
Previously Approved
07/31/2013
36 Months From Approved
07/31/2010
1,672,454
0
1,056,000
139,475
0
87,965
0
0
0
Grant funds are awarded by the Centers for Medicare & Medicaid Services (CMS) to states to provide information, counseling and assistance to beneficiaries relating to Medicare and Medicaid matters as well as Medicare supplemental policies, managed care options including Medicare Advantage, long-term care insurance, and other health insurance benefit information. States may carry out the objective of the grants by providing one-on-one counseling, either face-to-face or over the telephone, by trained volunteer staff, by distributing written informational materials, or by holding group educational seminars and presentations and outreach events.
The current Client Contact form, Public and Media Activity Report form, and Resource Report have been used to collect data to evaluate program effectiveness and improvement, and these forms expire June 30, 2010. In addition, the 2007-2009 SHIP Performance Assessment Workgroup (comprised of SHIP Directors and representatives from external organizations such as the Administration on Aging), in a report to CMS, recommended that changes be made to the forms in order to enhance the ability to measure performance and program evaluation for each SHIP; add additional data collection elements as requested by Congress and SHIPs (Limited English Proficiency and Dual Mentally Disabled); and reduce the burden of data submission by counselor as a result of the ability to pre-populate certain data cells.
US Code:
42 USC 1395b-4
Name of Law: Health insurance information, counseling, and assistance grants
PL:
Pub.L. 101 - 508 4360(F)
Name of Law: Health Insurance Information, Counseling, and Assistance Grants
The time estimate to complete the Client Contact Form and the time estimate to complete the Public and Media Activity Form remain unchanged since the last OMB submission. The current time estimate to complete the Resource Report Form is 30 minutes longer than the previous estimate, even though the current Resource Report Form is shorter. The diligence and quality of the Resource report data submitted by the State Directors has improved over recent years, thus accounting for the increased time estimate. However, the Resource Report reporting requirements have changed, resulting in only one Resource Report submission annually.
$422,311
No
No
No
Uncollected
No
Uncollected
William Parham 4107864669
Reginfo record details
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.
Form CMS-10028-B State Health Insurance Assistance Program (SHIP) Public and Media Activity Form
CMS-10028 Attachment C.doc
State Health Insurance Assistance Program (SHIP) Client Contact Form, Public and Media Activity Form, and Resource Report