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
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-A State Health Insurance Assistance Program (SHIP) Client Contact Form, Public and Media Activity Form, and Resource Report
CMS-10028 Attachment C.doc
State Health Insurance Assistance Program (SHIP) Client Contact Form, Public and Media Activity Form, and Resource Report