CMS-10437 Post Campaign Survey

Generic Social Marketing & Consumer Testing Research

CMS-10437.GenIC #3 - OMB OE POSTCAMPAIGN SURVEY

GenIC#3 - Medicare Open Enrollment Survey

OMB: 0938-1247

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PRA Disclosure Statement

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number.  The valid OMB control number for this information collection is 0938-1247.  The time required to complete this information collection is estimated to average 20 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection.  If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.  Please do not send applications, claims, payments, medical records or any documents containing sensitive information to the PRA Reports Clearance Office. Please note that any correspondence not pertaining to the information collection burden approved under the associated OMB control number listed on this form will not be reviewed, forwarded, or retained. If you have questions or concerns regarding where to submit your documents, please contact Kymeiria Ingram at (410)786-8431 or [email protected].


CMS OPEN ENROLLMENT POST CAMPAIGN CONSUMER RESEARCH


Objectives: For Open Enrollment, this assessment will address the following objectives:


  • Measure beneficiaries’ awareness of open enrollment

  • Measure beneficiaries’ perceptions of open enrollment

  • Measure beneficiary awareness of the need to review their health and drug plans

  • Measure beneficiary behavior regarding reviewing and comparing plans

  • Measure beneficiary understanding of their ability to change plans, and their awareness of what to look for and consider when comparing and contrasting such plans

  • Assess how the Open Enrollment campaign is making contact with beneficiaries, and the extent to which communications prompt action

  • Compare results with previous years to identify long term trends

  • Compare effectiveness of campaign in reaching beneficiaries via paid versus earned media

  • Assess demographics of weighted sample

  • Compare beneficiary responses on demographic variables


Good morning/afternoon/evening. This is _________. I am calling on behalf of Medicare from ___which is an independent research company. We are conducting a short survey today and your opinion is important to us. We are not selling anything and your responses are completely confidential. May I speak with someone who is between the ages of 65 and 80 years old? This person must reside at this address.

Shape1

DG2


S1. First, can you please tell me the year you were born? [DO NOT READ LIST]


RECORD YEAR _______ [4 DIGITS] RESPONSE WILL BE AUTOMATICALLY CODED]


Under 65

1

THANK AND END

65-66

2


67-70

3

71-75

4

76-80

5

81+

7

THANK AND END

DK

-1

Refused

-2

Shape2

DG1


S2. GENDER [DO NOT ASK]


Male

1

[CHECK QUOTAS]

Female

2

[CHECK QUOTAS]

Shape3

SG2


S3. Do you or does anyone in your household currently work for a health maintenance organization, a health insurance company, the Social Security Administration or the Centers for Medicare & Medicaid Services, formerly known as the Health Care Financing Administration?


Yes

1

THANK AND END

No

2


DK

-1

THANK AND END

Refused

-2



S4. Do you currently have Medicare or Medicaid benefits?

Shape4

ING1


Yes, covered by Medicare

1


Yes, covered by Medicaid

2


Yes, covered by both

3


No

4

THANK AND END

DK

-1


Refused

-2


Shape5

SG11


S4A. Do you have any medical or health-related disabilities? By disability I mean having difficulty hearing or seeing or having a physical, mental, or emotional condition that causes difficulty when running errands, climbing stairs, dressing or bathing, or making decisions.


Yes

1

CODE AS DISABLED

No

2


DK

-1

Refused

-2

Shape6

DG11


S5. What state do you live in? [IF RESPONDENT MENTIONS THAT THEY HAVE MULTIPLE HOMES/LIVE IN MULTIPLE STATES, SAY: “Please give me the state you live in at least six months out of the year or the state that you consider to be your primary residence.] [IF RESPONDENT REFUSES TO GIVE THEIR STATE, THANK AND END.]


RECORD STATE AND CLASSIFY INTO CENSUS DIVISION. _____


Shape7

SG4


S6. Within the past year, have you ever provided help, assistance or advice to a spouse, family member, friend, or other person with Medicare? This includes help with their Medicare insurance.


Yes

1


No

2

SKIP TO Q1

DK

-1

Refused

-2

Shape8

SG6


S7. What is your relationship to the person or persons you care for?


Paid caregiver/nurse/aide

1

Exclude from caregiver sample




Child

2

CLASSIFY AS CAREGIVER

Spouse

3

Sibling

4

Other family member

5

Other

6


[IF RESPONDENT REQUESTS ADDITIONAL INFORMATION ABOUT MEDICARE, PLEASE SAY, "You may call 1-800 MEDICARE for more information."] IF RESPONDENT ASKS WHAT THE SURVEY IS FOR, PLEASE SAY: “Medicare is conducting this survey because they want to improve how it serves beneficiaries like you. The information you provide will be used to improve the Medicare program.”


INFORMATION SOURCES


Our questions are about Medicare, the federal government’s health insurance program for seniors and some non-seniors with disabilities.

  1. Shape9

    ISG2

    Where would you say you get information about Medicare including the plans that are available to you? [DO NOT READ LIST. ACCEPT MULTIPLES. IF RESPONDENT SAYS “IN THE MAIL,” CLARIFY FROM WHERE – responses 1-4]


In the mail – from Medicare: A LETTER

1


In the mail – from Medicare: A PAMPHLET

2


In the mail – from Medicare: THE HANDBOOK

3


In the mail – from somewhere else (nonspecific)

4


Medicare and You handbook

5


1-800-MEDICARE

6


www.medicare.gov/(Medicare web site)

7


Physician or nurse

8


Pharmacist

9


Insurance or drug plan

10


Friends/family

11


Television, radio, newspaper, magazine

12


Senior Center

13


Health Fair

14


Internet (specify _____________)

15


Library

16


OTHER (Specify_____________)

17


DK

-1


Refused

-2


Shape10

KG3


  1. To the best of your knowledge, can you get answers to questions about Medicare… [READ EACH STATEMENT, WAIT FOR YES/NO. ALSO SAY “you can answer yes, no, or don’t know.” ROTATE STATEMENTS] [IF RESPONSE TO Q02, IS YES, IMMEDIATELY ASK Q03, OTHERWISE SKIP TO NEXT STATEMENT.]



Yes

No

DK

  1. Over the phone through 1-800-Medicare

1

2

-1

  1. Over the Internet at www.medicare.gov

1

2

-1

  1. Through the Medicare and You handbook

1

2

-1

  1. Through AARP

1

2

-1

  1. From local counselors

1

2

-1

  1. At senior centers

1

2

-1

  1. Through state or county offices on Aging

1

2

-1

  1. Through state insurance departments

1

2

-1

[NET CODE e-h IN BANNERS]



  1. Shape11

    BG7

    And have you ever used [USE LIST BELOW FOR EACH "YES" FROM Q02]?



Yes

No

DK

a. The 1-800 Medicare phone number

1

2

-1

b. www.medicare.gov website

1

2

-1

c. The Medicare and You handbook

1

2

-1

d. AARP

1

2

-1

e. Local counselors

1

2

-1

f. Senior centers

1

2

-1

g. State or county offices on Aging

1

2

-1

h. State insurance departments

1

2

-1

Shape12

BG7


  1. [FOR EACH YES TO Q3, IMMEDIATELY FOLLOW UP WITH “And was that in the past three months?]


Yes

1


No

2


DK

-1


Shape13

DMG4A


  1. In the past three months, have you talked about or discussed your Medicare Plan with anyone?


Yes

1


No

2


DK

-1

Refused

-2



DECISION MAKER

Shape14

DMG1


  1. When it comes to your Medicare coverage and services, do you usually… [READ LIST.] [IF RESPONDENT STATES 'ON MY OWN', CLARIFY 'IS THAT ON YOUR OWN, WITHOUT TALKING TO ANYONE ELSE', OR 'ON YOUR OWN, BUT TALK WITH OTHERS ABOUT IT']


make those decisions on your own, without talking to anyone else

1

SKIP TO Q9A

make those decisions on your own, but talk with others about it

2


make those decisions with someone else’s help

3

rely on someone else to make those decisions for you

4


[IF CODE 3 OR 4 ON Q8, FOR Q9, Q11, Q24, Q25, and Q26 , INSERT “or the person who helps you”]

Shape15

DMG2


  1. Who do you [or the person who helps you] talk with about these decisions? [IF Q8=4, ASK “Who makes these decisions for you?] [DO NOT READ LIST. ACCEPT MULTIPLES.]


Spouse

1


Child

2


Other family member

3


A friend

4


Receive help at a senior center

5


Receive help from my state’s health insurance dept.

6


Other (specify) ____________

7



9A. Have you ever looked for information on health topics like staying healthy and preventing disease, managing ongoing conditions like pain, arthritis, or diabetes; or changes in benefits?

Shape16

SOI1


Yes

1


No

2


DK

-1

Refused

-2


Shape17

ATG1

9X. Now tell me how much you agree or disagree with the following statements. Use a scale where 1 means you completely disagree and 7 means you completely agree. The first statement is…[READ AND ROTATE STATEMENTS].I think there is a mismatch between these questions and the ones included in the 10-item algorithm – I’ll attach spreadsheet w items to compare. Also see income categories – they are also different than those specified in the scoring.


  1. Someone else takes care of health care issues so I don’t really need to

1


  1. It is very important for me to be informed about health issues

2


  1. I have other people I can always turn to if I need help

3


  1. I’m concerned about not being able to pay for healthcare

4


  1. I have a financial plan that includes funding for future healthcare costs

5


  1. Most health issues are too complex for me to understand

6


  1. I have difficulty understanding a lot of the health information that I read

7


  1. It is hard to find good answers to my health questions and concerns

8



INSURANCE COVERAGE

Shape18

ING2


  1. And thinking about the insurance you have for doctor and hospital coverage, would you say you are satisfied or unsatisfied with your insurance coverage? [PROMPT, SAY “And is that very (satisfied/unsatisfied) or somewhat (satisfied/unsatisfied)?]


Very unsatisfied

1


Somewhat unsatisfied

2


Somewhat satisfied

3


Very satisfied

4


DK

-1


Refused

-2


Shape19

ING9


10A. Does your insurance plan allow you to go to any doctor you choose or do you have to pick from a list of doctors provided by the insurance company?


Can go to any doctor

1


Must pick doctor from a list

2


DK

-1

Refused

-2

Shape20

ING7


10B. Some seniors have additional health insurance or supplemental insurance to cover some of the expenses that are not covered by Medicare. These include a supplement that you might get from your employer or union. Do you have any of the following? [READ LIST. ROTATE STATEMENTS] [ACCEPT MULTIPLES.]


Medigap or Medicare Supplemental insurance

1


Insurance through your employer or union

2

Military retiree benefits, also called tri-care

3

A Medicare HMO or PPO not from an employer or union, sometimes called a Medicare Advantage Plan

4

Other SPECIFY

5

None

6

DK

-1

Refused

-2

  1. Shape21

    ING6

    Now I’d like to ask you about insurance for prescription drugs. Do you have one of the Medicare prescription drug plans, also known as Medicare Part D?


Yes

1

SKIP TO Q14

No

2


DK

-1

Refused

-2

Shape22

ING5


  1. Do you have other insurance coverage that pays for your prescription drugs?


Yes

1


No

2

SKIP TO Q15

DK

-1

Refused

-2


Shape23

ISG1


  1. Thinking about your Medicare prescription drug plan in general, would you say you are satisfied or unsatisfied with your prescription coverage? [PROMPT, SAY “And is that very (satisfied/unsatisfied) or somewhat (satisfied/unsatisfied)?]


Very unsatisfied

1


Somewhat unsatisfied

2


Somewhat satisfied

3


Very satisfied

4


DK

-1


Refused

-2



OPEN ENROLLMENT AWARENESS AND PREVIOUS BEHAVIOR

Shape24

KG7


  1. Please tell me if the following statement is true or false. “Each year, Medicare has an open enrollment period when people on Medicare can decide to make changes to their insurance coverage and switch to a different plan.”


True

1


False

2


DK

-1


Refused

-2


Shape25

PG5


16B. Which of the following are the correct start and end dates for Open Enrollment? Is it from…[READ LIST.]


October 1 to March 31

8


October 15 to December 7

2


November 15 to December 31

1


January 1 to February 28

4


Some other dates

5


None of these dates

6


[DO NOT READ] DK

-1


[DO NOT READ] Refused

-2



  1. Have you recently seen, read, or heard any information about Medicare Open Enrollment?

Shape26

AWG5


Yes

1


No

2

SKIP TO Q22

DK

-1

Shape27

AWG5

Refused

-2

  1. More specifically, have you recently seen, read or heard about Medicare Open Enrollment… [READ AND ROTATE LIST. AFTER EACH STATEMENT PAUSE. ACCEPT MULTIPLE RESPONSE.]

Shape28

AWG5


  1. [FOR EACH YES, IMMEDIATELY FOLLOW UP WITH “And was that in an advertisement (like a commercial), OR a news piece or article, OR both?”]

Shape29

AWG2B


19G. And was that in an advertisement (g only: ON THE INTERNET: “along the top or on the side of a web page”) OR a news piece or article, OR both?



Q.18

Q.19


Yes

No

Adv

News/

Article

Both

(Do Not Read) Other Specify

DK

  1. On television

1

2

1

2

3

_______

-1

  1. On the radio

1

2

1

2

3

_______

-1

  1. In a newspaper

1

2

1

2

3

_______

-1

  1. In a magazine

1

2

1

2

3

_______

-1

  1. In the mail

1

2

DO NOT ASK FOR 19E “In the mail”

  1. [DELETE]








  1. On the Internet

1

2

1

2

3

_______

-1

  1. Through word of mouth

1

2

DO NOT ASK


Shape30

AWG6

[IF CODE “1” OR “3” ON Q19 FOR ANY RESPONSE, CONTINUE. ELSE SKIP TO Q20B]

Shape31

AWG6


  1. Shape32

    AWG6

    Now I’m going to describe an ad to you that you may or may not have seen on TV. You may or may not have seen the ad because it is NOT running in all parts of the country. But in the past month, did you happen to see an ad that…



Yes

1


No

2

SKIP TO Q22

DK

-1

Shape33

PE8

Refused

-2


Q20C And how personally relevant would you say this ad was for you? Was it [READ LIST]


Very relevant

5


Somewhat relevant

4


Neither relevant nor irrelevant

3


Not very relevant

2


Not relevant at all

1


[DO NOT READ] DK

-1


[DO NOT READ] Refused

-2




KNOWLEDGE, ATTITUDES, AND PERCEPTIONS OF OPEN ENROLLMENT

Shape34

AW2


  1. Here are some short phrases. For each phrase, please tell me if you think it is True or False. If you don’t know, just let me know. [READ AND ROTATE STATEMENTS a-h]


True

False

Haven’t heard

DK

Refuse

  1. The costs that I have to pay out of my pocket for Medicare plans can change from year to year.

1

2

3

-1

-2

  1. Monthly premiums for Medicare plans can change from year to year.

1

2

3

-1

-2

  1. The drugs covered by Medicare plans can change from year to year.

1

2

3

-1

-2

  1. People with Medicare can switch insurance plans during the open enrollment period.

1

2

3

-1

-2

  1. Plan comparison information is available in the Medicare and You handbook.

1

2

3

-1

-2

  1. Plan comparison information is available on www.Medicare.gov

1

2

3

-1

-2

  1. DELETED






  1. People with limited income may qualify for financial assistance to help lower their prescription drug costs

1

2

3

-1

-2

Shape35

KG2


  1. Do you agree or disagree with the following statement: I have the information and resources I need to make an informed comparison among different Medicare plan choices. [PROMPT, SAY “And do you completely (agree/disagree) or somewhat (agree/disagree)?]


Completely disagree

1


Somewhat disagree

2


Somewhat agree

3


Completely agree

4


DK

-1


Refused

-2



REVIEW OF COVERAGE

  1. Shape36

    BG9

    During the last open enrollment period, did you (or the person who helps you) review your insurance coverage to see if there were going to be changes in the monthly premium, deductibles, co-payments, or other out of pocket expenses? [DO NOT READ LIST.]


Yes, I did

1


No, I did not

2


Not applicable – 2014 was 1st year I was enrolled in a Medicare plan

3


Yes, the person who helped me did

4

[ONLY SHOW IF CODE “2”, “3”, OR “4” ON Q.8]

No, the person who helped me did not

5

Don’t recall what I did

6

Don’t recall what the person who helped me did

7

DK

-1


Refused

-2


Shape37

KG7


  1. During the last open enrollment period, did you (or the person who helps you) review your insurance coverage to see if the kinds of treatment, drugs and services covered will meet your health care needs? [DO NOT READ LIST.]


[USE SAME CODE LIST FROM Q24]

Shape38

IUG18


  1. Did you (or the person who helps you) compare your plan with other plans that are available? [DO NOT READ LIST.]


[USE SAME CODE LIST FROM Q24]


[ASK Q26A ONLY IF "YES" CODE 1 OR 4 AT Q26. OTHERWISE SKIP TO Q27].

Shape39

ISG4


26A. When you compared plans, did you compare the… [READ EACH STATEMENT AND ASK, "YES OR NO". . ROTATE. ACCEPT MULTIPLE]



Yes

No

Don't Know
(DO NOT READ)

aa. Cost of plans

1

2

-1

bb. Drugs covered

1

2

-1

cc. Doctors covered

1

2

-1

dd. Treatments covered

1

2

-1

ee. Quality ratings

1

2

-1


  1. Shape40

    ATG1

    For the following statements, please tell me if you believe the statement is true or false. [READ AND ROTATE ORDER. PROBE FOR BEST GUESS ONLY ONCE IF DK ANSWER GIVEN. THEN ACCEPT DK]


True

False

Don’t understand subject

DK

Refused

  1. People with Medicare will receive more than 50% off brand name drugs if they enter the donut hole.

1

2

3

-1

-2

  1. Medicare beneficiaries are eligible to receive a free Annual Wellness Visit.

1

2

3

-1

-2

  1. DELETE

1

2

3

-1

-2

  1. Medicare provides 100% coverage for many preventive health tests, such as colonoscopy.

1

2

3

-1

-2

  1. Out of pocket costs are the same in all Medicare prescription drug plans

1

2

3

-1

-2

  1. All Medicare prescription drug plans cover the same list of prescription drugs

1

2

3

-1

-2


CURRENT HEALTH BEHAVIORS

Shape41

BG3


  1. How often do you take a list of all your prescription medicines to your doctor visits? [READ LIST]


Never

1


Sometimes

2


Usually

3


Always

4


Not applicable, not on prescription meds

5


DK

-1


Refused

-2


Shape42

BG3


28X.How often do you bring a list of questions you want to cover to your doctor visits? [READ LIST]


Never

1


Sometimes

2


Usually

3


Always

4


DK

-1


Refused

-2


Shape43

PG7


  1. Shape44

    DMG4

    How confident are you that you can identify when it is necessary for you to get medical care? [READ LIST]


Not at all confident

1


Somewhat confident

2


Confident

3


Very confident

4


DK

-1


Refused

-2



29A Before today, have you heard anything about the new Health Insurance Marketplace or Exchanges that will help people who are uninsured get coverage?


Yes

1


No

2

SKIP TO Q30

DK

-1

Refused

-2

Shape45

KG3


29B. For the following statements, please tell me if you believe the statement is true or false. If you don’t know, just let me know. [READ AND ROTATE ORDER. PROBE FOR BEST GUESS ONLY ONCE IF DK ANSWER GIVEN. THEN ACCEPT DK]


True

False

DK

Refused

  1. People with Medicare cannot buy health insurance on the new Health Insurance Marketplace.

1

2

-1

-2

  1. [DELETE]





  1. Medicare beneficiaries can keep using their health insurance the same as always

1

2

-1

-2

Shape46

KG3


29C To the best of your knowledge, will anything about your Medicare coverage be changed because of the Health Insurance Marketplace?


Yes

1


No

2

SKIP TO Q30

DK

-1

Refused

-2


29D And how do you think your Medicare coverage will be changed? Please be specific. [RECORD VERBATIM]






INTERNET USAGE

Shape47

IUG4


  1. How often do you use the internet on your own or with someone else’s help? [READ LIST IF NECESSARY.]


Daily or almost daily

1


Once or twice a week

2


Once or twice a month

3


Only a few times a year

4


Don’t have internet access/don’t use the internet

5

SKIP TO Q35

DK

-1


Refused

-2


Shape48

IUG6


  1. Consumers can subscribe to various high speed connections to the Internet, including DSL, cable, broadband, satellite or WiFi. Do you or does your household have a high-speed connection to the Internet?


Yes

1


No

2


DK

-1

Shape49

IUG8

Refused

-2

31A. What devices do you use to go on the Internet? If you don’t have the item, just let me know. [READ LIST. ACCEPT MULTIPLE. ROTATE]


A personal computer or laptop (like a PC or Mac)

1


A tablet (like an iPad, Galaxy, Kindle, or Nook)

2


A smart phone (like an iPhone or Android phone)

3


DK

-1


Refused

-2


Shape50

DMG4


  1. Have you ever heard of any of the following websites? [IMMEDIATELY FOLLOW EACH “YES” WITH Q33 “Have you ever visited this site?”].



Yes

No

No Internet

  1. w w w dot Medicare dot gov

1

2

3

  1. w w w dot Healthcare dot gov

1

2

3

  1. w w w dot Stop Medicare Fraud dot gov

1

2

3



  1. [ASK Q33 IMMEDIATE AFTER EACH ‘YES’ IN Q32.] Have you ever visited this site?

Shape51

BG5



Yes

No

No Internet

  1. w w w dot Medicare dot gov

1

2

3

  1. w w w dot Healthcare dot gov

1

2

3

  1. w w w dot Stop Medicare Fraud dot gov

1

2

3



ADDITIONAL DEMOGRAPHICS


We are nearing the end of the survey. Just a few more questions.

Shape52

HSG3


  1. Compared to other people who are the same age as you, do you consider you health to be … [READ LIST. ROTATE START WITH POSITIVE AND NEGATIVE END OF SCALE].


Poor

1


Fair

2


Good

3


Very Good

4


Excellent

5


DK

-1


Refused

-2


Shape53

HSG2


  1. Do you have any chronic health conditions that require ongoing care, such as arthritis, diabetes, chronic pain, high blood pressure, or heart disease?


Yes

1


No

2


DK

-1

Refused

-2


Shape54

BG2


  1. How many prescription drugs, if any, do you regularly take? [0-50, USE 98=DON’T KNOW, 99=REFUSED]


Shape55

DG6

RECORD NUMBER _______

  1. What is your current marital status? [IF NECESSARY, READ LIST]


Married

1


Divorced

2


Separated

3


Widowed

4


Single, never married

5


DK

-1


Refused

-2


Shape56

DG5


  1. What is the highest level of education that you have completed? [DO NOT READ LIST. CLARIFY AS NEEDED.]


Grade school or less

1


Some high school

2


Graduated high school/GED

3


Vocational/Technical school

4


Some college/2 years or less

5


Some college/ more than 2 years

6


Graduated college

7


Post-graduate degree (e.g. PhD or masters degree)

8


DK

-1


Refused

-2


Shape57

DG3


  1. Are you Hispanic or Latino? [IF NECESSARY, CLARIFY “For instance, Mexican American, Cuban, or Puerto Rican”]


Yes

1


No

2


DK

-1

Refused

-2

Shape58

DG4


  1. What is your racial or ethnic background? [IF NECESSARY, READ LIST.] [ACCEPT MULTIPLES.]


White

1


Black

2


Asian

3


American Indian

4


Native Hawaiian or other Pacific Islander

5


Other (Specify__________)

6


DK

-1


Refused

-2


Shape59

SG3


42A Do you speak a language other than English at home?


Yes

1


No

2

SKIP TO Q44

DK

-1

Refused

-2



Shape60

DG10


  1. What is the annual income of your household before taxes and deductions? Is it - (IF NECESSARY, READ LIST)? Can we use the categories that are used in the segmentation algorithm --


Under $15,000

1


$15,000 to under $25,000

2

$25,000 to under $50,000

3

$50,000 to under $75,000

4

$75,000 to under $100,000

5

$100,000 to under $150,000

6

$150,000 to under $200,000

7

$200,000 or more

8

DK

-1

Refused

-2


Thank you for your time. Your opinions are very valuable to Medicare and will help improve their services.


25


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File Title2014 CMS OE Post Campaign Questionnaire
Authorjlam
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File Created2021-01-29

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