Generic Social Marketing & Consumer Testing Research

Forms and Documents

Document Name	Status
Form CMS-10437 - GenIC# GenIC#14 - Medicare Beneficiary Consumer Survey Form and Instruction	New
Form CMS-10437 GenIC#13 - Qualitative Research on Communications and Decision Support for Provider Initiatives 2017 Form and Instruction	New
Form CMS-10437 (GenIC#1 GenIC #12 - Web Intercept Survey of HealthCare.gov Visitors Form and Instruction	New
Form CMS-10437 GenIC#11 - CMS Consumer Research on Websites and Tools Form and Instruction	New
Form CMS-10437.GenIC#10 GenIC#10 - Quality Payment Program Provider Awareness Tracking Survey Form and Instruction	New
Form CMS-10437 GenIC#8 Qualitative Testing of Creative Materials (GenIC#8) Form and Instruction	New
Form CMS-10427. GenIC#7 Formative Research on Communications and Decision Support in Marketplace 2017 Form and Instruction	New
Form CMS-10437 Medicare Beneficiary Consumer Survey Form and Instruction	New
Form CMS-10437 GenIC#5 - Consumer Survey of Marketplace Disenrollees Form and Instruction	New
Form CMS-10437-GenIC#4 GenIC # 4: Web Intercept Survey of HealthCare.gov Visitors Form and Instruction	New
Form CMS-10437 GenIC#3 - Medicare Open Enrollment Survey Form and Instruction	New
Form CMS-10437 (GenIC#1 GenIC#1 - Consumer Testing for the Health Insurance Marketplace's (HIM) Quality Rating System (QRS): Phase 1, Wave 1-Terminology Related to the Health Insurance and Quality Form and Instruction	New
Form CMS-10437: GenIC#2 GenIC#2 - 2015 Online Provider Assessment Survey Form and Instruction	New
Response to 30-day Public Comments CMS-10437_FF_7-31-13.doc Supplementary Document	2013-08-08
CMS-10437.SupStatemtB-GenericSM051013.docx Supporting Statement B	2013-07-23
GenericSMTestingItemBank051013.docx Supplementary Document	2013-07-23
CMS-10437.SupStatemtA-GenericSM-PRA051013.docx Supporting Statement A	2013-07-23

IC Document Collections

IC ID	Document Title	Status
227110	GenIC#14 - Medicare Beneficiary Consumer Survey Form and Instruction	New
226609	GenIC#13 - Qualitative Research on Communications and Decision Support for Provider Initiatives 2017 Form and Instruction	New
226507	GenIC #12 - Web Intercept Survey of HealthCare.gov Visitors Form and Instruction	New
226386	GenIC#11 - CMS Consumer Research on Websites and Tools Form and Instruction	New
226169	GenIC#10 - Quality Payment Program Provider Awareness Tracking Survey Form and Instruction	New
225019	Qualitative Testing of Creative Materials (GenIC#8) Form and Instruction	New
224399	Formative Research on Communications and Decision Support in Marketplace 2017 Form and Instruction	New
222296	Medicare Beneficiary Consumer Survey Form and Instruction	New
219994	GenIC#5 - Consumer Survey of Marketplace Disenrollees Form and Instruction	New
218875	GenIC # 4: Web Intercept Survey of HealthCare.gov Visitors Form and Instruction	New
218112	GenIC#3 - Medicare Open Enrollment Survey Form and Instruction	New
217808	GenIC#1 - Consumer Testing for the Health Insurance Marketplace's (HIM) Quality Rating System (QRS): Phase 1, Wave 1-Terminology Related to the Health Insurance and Quality Form and Instruction	New
217697	GenIC#2 - 2015 Online Provider Assessment Survey Form and Instruction	New

ICR Details

OMB Control No: 0938-1247	ICR Reference No: 201307-0938-017
Status: Historical Active	Previous ICR Reference No: 201210-0938-001
Agency/Subagency: HHS/CMS	Agency Tracking No: 20138
Title: Generic Social Marketing & Consumer Testing Research
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/13/2014
	Date Received in OIRA: 07/23/2013
Terms of Clearance: OMB approves this collection for a period of three years. To request approval of information collections under this generic approval, the agency must do the following: 1) Unless an agency is using multiple modes of collection (e.g., paper forms and electronic submissions), provide a Generic Clearance Submission Template for each Instrument; 2) If the agency is using multiple modes of collection (e.g., paper forms and electronic submissions), the same Generic Clearance Submission Template may be used for both instruments; 3) each Generic Clearance Submission Template must be uploaded as a Supplementary document using a naming convention that allows the public to identify the associated instrument; 4) submit no more than five Generic Submission Templates with each request. 5) collections approved under this Generic will not be used to make population estimates or to provide generalizable results.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2017	36 Months From Approved
Responses	41,592	0	0
Time Burden (Hours)	21,488	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The purpose of this submission is to request an Information Collection Request (ICR) generic clearance for a program of consumer research aimed at a broad audience of those affected by CMS programs including Medicare, Medicaid, Children's Health Insurance Program (CHIP), and health insurance marketplace (a.k.a. "exchanges"). This program extends strategic efforts to reach and tailor communications to beneficiaries, caregivers, providers, stakeholders, and any other audiences that would support the Agency in improving the functioning of the health care system, improve patient care and outcomes, and reduce costs without sacrificing quality of care. With the clearance, CMS will create a proactive process for rapid collection of data to inform development of communications as well as providing rapid feedback on service delivery for continuous improvement of programs and communications aimed at diverse CMS target audiences.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 1103 Name of Law: Affordable Care Act
   PL: Pub.L. 111 - 148 4004 Name of Law: Affordable Care Act
   PL: Pub.L. 111 - 148 2001, 2101 Name of Law: Affordable Care Act
   PL: Pub.L. 111 - 148 1003 Name of Law: Affordable Care Act
   PL: Pub.L. 111 - 148 Sec 3022, 2706, 2703 Name of Law: Affordable Care Act
   PL: Pub.L. 111 - 148 3021 Name of Law: Affordable Care Act
   PL: Pub.L. 111 - 148 2602 Name of Law: Affordable Care Act
   PL: Pub.L. 111 - 148 3001, 3209 Name of Law: Affordable Care Act
   PL: Pub.L. 111 - 148 10303, 10327, 10331, 2701 Name of Law: Affordable Care Act
  

Citations for New Statutory Requirements: PL: Pub.L. 111 - 148 2601, 2602 Name of Law: Affordable Care Act
PL: Pub.L. 111 - 148 1103 Name of Law: Affordable Car Act
PL: Pub.L. 111 - 148 4004 Name of Law: Affordable Care Act
PL: Pub.L. 111 - 148 2001 & 2101 Name of Law: Affordable Care Act
PL: Pub.L. 111 - 148 1003 Name of Law: Affordable Care Act
PL: Pub.L. 111 - 148 3022, 2706, 2703 Name of Law: Affordable Care Act
PL: Pub.L. 111 - 148 3021 Name of Law: Affordable Care Act
PL: Pub.L. 111 - 148 3001, 3209 Name of Law: Affordable Care Act

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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:
	78 FR 3899	01/17/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 32658	05/31/2013
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 13

IC Title	Form No.	Form Name
GenIC#3 - Medicare Open Enrollment Survey	CMS-10437, CMS-10437	Pre Campaign Survey ,   Post Campaign Survey
Medicare Beneficiary Consumer Survey	CMS-10437	Medicare Beneficiary Consumer Survey
GenIC # 4: Web Intercept Survey of HealthCare.gov Visitors	CMS-10437-GenIC#4	Web Intercept Survey of HealthCare.gov Visitors
Qualitative Testing of Creative Materials (GenIC#8)	CMS-10437 GenIC#8	Qualitative Testing Creative Materials Focus Group Guide
GenIC #12 - Web Intercept Survey of HealthCare.gov Visitors	CMS-10437 (GenIC#12)	Web Intercept Survey
GenIC#10 - Quality Payment Program Provider Awareness Tracking Survey	CMS-10437.GenIC#10	Quality Payment Program Provider Awareness Tracking Survey
Formative Research on Communications and Decision Support in Marketplace 2017	CMS-10427. GenIC#7	Marketplace 2017 Focus Group Guide
GenIC#14 - Medicare Beneficiary Consumer Survey	CMS-10437 - GenIC#14	Medicare Beneficiary Consumer Survey
GenIC#1 - Consumer Testing for the Health Insurance Marketplace's (HIM) Quality Rating System (QRS): Phase 1, Wave 1-Terminology Related to the Health Insurance and Quality	CMS-10437 (GenIC#1)	QRS Wave 1 Interview Guide
GenIC#5 - Consumer Survey of Marketplace Disenrollees	CMS-10437	Consumer Survey of Marketplace Disenrollees
GenIC#2 - 2015 Online Provider Assessment Survey	CMS-10437: GenIC#2	2015 Online Provider Assessment Survey
GenIC#11 - CMS Consumer Research on Websites and Tools	CMS-10437	GenIC#11 - CMS Consumer Research on Websites and Tools
GenIC#13 - Qualitative Research on Communications and Decision Support for Provider Initiatives 2017	CMS-10437	GenIC#13 - Qualitative Research on Communications and Decision Support for Provider Initiatives 2017

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ICR Summary 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	41,592	0	41,592	0	0	0
Annual Time Burden (Hours)	21,488	0	21,488	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new information collection request.

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Annual Cost to Federal Government: $2,000,000

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]? Yes

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: 07/23/2013

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