Information Collection Request

Medicare Beneficiary and Family-Centered Satisfaction Survey

ICR 201204-0938-001 · OMB 0938-1177 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form CMS-10393 Medicare Beneficiary and Family-Centered Satisfaction Survey Form Modified Repair queued
Use of Satisfaction Survey Data.docx Supplementary Document Uploaded 2012-09-04 Repair queued
Beneficiary Cognitive testing Report.docx Supplementary Document Uploaded 2012-09-04 Available
BENE_ENV_BRM (reply envelope).pdf Supplementary Document Uploaded 2012-09-04 Available
BENE_#10 (for sending reminder letter .pdf Supplementary Document Uploaded 2012-09-04 Repair queued
Bene Survey Letter 2 (Reminder)_complaints Eng-Span.docx Supplementary Document Uploaded 2012-09-04 Repair queued
Bene Survey Letter 2 (Reminder)_appeals Eng-Span.docx Supplementary Document Uploaded 2012-09-04 Repair queued
Bene Survey Letter 1 Eng-Span.docx Supplementary Document Uploaded 2012-09-04 Repair queued
Bene Letter 3 Eng-Span.docx Supplementary Document Uploaded 2012-09-04 Repair queued
BENE 9x12 OE (sending cover letter and survey).pdf Supplementary Document Uploaded 2012-09-04 Repair queued
Revised PRA Supporting Stmt-Pt B (082812).docx Supporting Statement B Uploaded 2012-09-04 Available
Public Comments Response-032212.docx Supplementary Document Uploaded 2012-03-27 Repair queued
CMS Medicare Beneficiary Survey Revision Crosswalk 022912.docx Supplementary Document Uploaded 2012-03-27 Repair queued
Revised PRA Supporting Stmt-Pt A (082812).docx Supporting Statement A Uploaded 2012-09-04 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
201543 Medicare Beneficiary and Family-Centered Satisfaction Survey Form Modified
ICR Details
0938-1177 201204-0938-001
Historical Active 201203-0938-008
HHS/CMS
Medicare Beneficiary and Family-Centered Satisfaction Survey
Existing collection in use without an OMB Control Number   No
Regular
Approved with change 09/25/2012
Retrieve Notice of Action (NOA) 04/03/2012
  Inventory as of this Action Requested Previously Approved
09/30/2015 36 Months From Approved
68,000 0 0
17,000 0 0
85,000 0 0

The data collection methodology used for the Beneficiary Satisfaction flows from the proposed sampling approach. While it was feasible to conduct the 9th SOW via telephone data collection only, with a quarterly sample size for the 10th SOW estimated to be 2,664, it does not seem efficient to maintain a telephone only data collection approach. Based on recent literature on survey methodology and response rates by mode, we recommend using a data collection that is primarily mail. A mail-based methodology will achieve the goals of being efficient, effective, and minimally burdensome for beneficiary respondents. As previously described, we anticipate that a mail-based methodology could yield a response rate of approximately 60 percent. In order to achieve this response rate, we would recommend a 3 staged approach to data collection: 1) Mailout of a covering letter, the paper survey questionnaire, and a postage-paid return envelope. 2) Mailout of a post card that thanks respondents and reminds the non-respondents to please return their survey. 3) Mailout of a follow-up covering letter, the paper survey questionnaire, and a postage-paid return envelope. Through the pilot test, we will determine the response rate that can be achieved using this approach. If it is deemed necessary, additional mailout reminders can be added to the protocol, or a telephone non-response step can be added to the protocol. Using the 3-step mail approach described above, we anticipate that data collection would occur over an 8 to 10 weeks.

US Code: 42 USC 1320c Name of Law: Functions of Peer Review Organizations
  
US Code: 42 USC 1320-c Name of Law: Functions of Peer Review Organizations

Not associated with rulemaking

  76 FR 34076 06/10/2011
77 FR 14806 03/13/2012
Yes

1
IC Title Form No. Form Name
Medicare Beneficiary and Family-Centered Satisfaction Survey CMS-10393, CMS-10393 Bene Survey Appeals ,   Bene Survey Complaint

  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 68,000 0 0 0 0 68,000
Annual Time Burden (Hours) 17,000 0 0 0 0 17,000
Annual Cost Burden (Dollars) 85,000 0 0 0 0 85,000
No
No

$2,024,620
Yes Part B of Supporting Statement
No
No
No
No
Uncollected
Denise King 410 786-1013 [email protected]

  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.
04/03/2012