Medicare Beneficiary and Family-Centered Satisfaction Survey

ICR 201305-0938-002

OMB: 0938-1177

Federal Form Document

Forms and Documents
Document
Name
Status
Form
 Modified
Justification for No Material/Nonsubstantive Change
2013-04-30
Supplementary Document
2013-04-30
Supplementary Document
2013-04-30
Supplementary Document
2013-04-30
Supplementary Document
2013-04-30
Supplementary Document
2012-03-27
IC Document Collections
IC ID
Document
Title
Status
201543 Modified
ICR Details
0938-1177 201305-0938-002
Historical Active 201204-0938-001
HHS/CMS 19423
Medicare Beneficiary and Family-Centered Satisfaction Survey
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 06/10/2013
Retrieve Notice of Action (NOA) 05/01/2013
  Inventory as of this Action Requested Previously Approved
09/30/2015 09/30/2015 09/30/2015
68,000 0 68,000
17,000 0 17,000
85,000 0 85,000
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
  
None
Not associated with rulemaking
Yes
1
IC Title Form No. Form Name
Medicare Beneficiary and Family-Centered Satisfaction Survey CMS-10393, CMS-10393 Bene Complaint Survey ,   Bene Appeals Survey
  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 68,000 0 0 0 0
Annual Time Burden (Hours) 17,000 17,000 0 0 0 0
Annual Cost Burden (Dollars) 85,000 85,000 0 0 0 0
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.
05/01/2013
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