1-800-MEDICARE Beneficiary Satisfaction Survey (CMS-100098)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
OMB Supporting Statement - Part B.doc	Supporting Statement B	Uploaded 2011-02-23	Available
OMB Crosswalk and Track Changes.doc	Supplementary Document	Uploaded 2011-02-23	Available
OMB Supporting Statement Part A (3).doc	Supporting Statement A	Uploaded 2011-02-23	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
8763	1-800 MEDICARE Beneficiary Satisfaction Survey (Interactive Voice Response-IVR)	Instruction	Modified
196720	1-800 MEDICARE Beneficiary Satisfaction Survey (Written Correspondence)	Instruction	New
196719	1-800 MEDICARE Beneficiary Satisfaction Survey (Outbound Telephone Survey)	Instruction	New
196718	1-800 MEDICARE Beneficiary Satisfaction Survey (E-mail)	Instruction	New
196717	1-800 MEDICARE Beneficiary Satisfaction Survey (Web Chat)	Instruction	New

ICR Details

OMB Control No: 0938-0919	ICR Reference No: 201103-0938-003
Status: Historical Active	Previous ICR Reference No: 200703-0938-011
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: 1-800-MEDICARE Beneficiary Satisfaction Survey (CMS-100098)
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/19/2011
	Date Received in OIRA: 03/04/2011
Terms of Clearance: This collection is approved for one year. By the time of the next submission, CMS will reframe this collection as a "generic information collection request."

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2012	36 Months From Approved
Responses	36,144	0	0
Time Burden (Hours)	6,032	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Beneficiary Satisfaction survey is performed to insure that the CMS 1-800-MEDICARE Helpline contractor is delivering satisfactory service to the Medicare beneficiaries. It gathers data on several Helpline operations such as print fulfillment and website sites tool hosted on www.medicare.gov. Respondents to the survey are Medicare beneficiaries that have contacted 1-800-MEDICARE within the past week for benefits and services information.

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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:
	75 FR 76988	10/10/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 9579	02/18/2011
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 5

table that charts list of burden

IC Title	Form No.	Form Name
1-800 MEDICARE Beneficiary Satisfaction Survey (Interactive Voice Response-IVR)
1-800 MEDICARE Beneficiary Satisfaction Survey (Web Chat)
1-800 MEDICARE Beneficiary Satisfaction Survey (E-mail)
1-800 MEDICARE Beneficiary Satisfaction Survey (Outbound Telephone Survey)
1-800 MEDICARE Beneficiary Satisfaction Survey (Written Correspondence)

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ICR Summary of Burden

table that charts list 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	36,144	0	0	23,112	0	13,032
Annual Time Burden (Hours)	6,032	0	0	4,403	0	1,629
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: CMS is seeking approval of additional customer satisfaction survey questions. The original questions were designed to evaluate service when a beneficiary contacted Medicare by phone. The new expanded collection will measure not only contact via the telephone but also services provided through written correspondence, e-mail, and web chat. The use of Customer Satisfaction Surveys is critical to the CMS mission of providing service to beneficiaries that is convenient, accessible, accurate, courteous, professional and responsive to the needs of diverse groups. SEE Supporting Statement A for additional information

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Annual Cost to Federal Government: $226,060

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]? No

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: 03/04/2011

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