CMS-10437.GenIC #5 - Application to Use Burden hours -Consumer Survey of Marketplace Disenrollees

Application to Use Burden/Hours from Generic PRA Clearance:

Generic Social Marketing & Consumer Testing Research

(CMS-10437, OMB 0938-1247)

Generic Information Collection (GenIC) # 5: Consumer Survey of Marketplace Disenrollees

Office of Communications (OC)

Centers for Medicare & Medicaid Services (CMS)

A. Background

The Office of Communications/Strategic Marketing Group/Division of Research will be conducting a survey of Marketplace Health Insurance Plan enrollees and disenrollees. Survey respondents will be generally representative of the diverse population of audiences/customers that are served by the online Health Insurance Marketplace. The survey will measure consumer perceptions and experiences related to their health insurance decisions. The survey is designed and organized into several sections: health insurance status, health status, behaviors, perceptions, and demographics. The survey is brief -- time to complete the survey is expected to be approximately 6 minutes. The main goal of the survey will be to characterize individuals that disenroll from Marketplace plans and to identify areas for continuous quality improvement in our information dissemination and communication activities. The survey is part of a continuing data collection program mandated by the Affordable Care Act. Results of the survey will be shared with CMS stakeholders and used to improve the web portal and other communication-related activities.

B. Description of Information Collection

The data will be professionally collected using mixed mode methodology that combines an online questionnaire [n = 700] and a telephone survey [n = 300]. Eligible participants will be invited to participate and will have the opportunity to opt-out.

Individual respondents are expected to spend an average of six (6) minutes completing the survey.

No incentives will be offered for completing the survey.

Items will be drawn from the generic item pool and formatted for internet presentation. The survey will include:

C. Deviations from Generic Request

None

D. Burden Hour Deduction

1,000 participants * 0.01 hours = 100 hours

E. Timeline

The following attachments are provided for this information collection:

Study Initiation Request Form (Consumer Survey of Marketplace Disenrollees)

Survey Instrument – Disenrollee Survey Instrument