Parts C and D Complaints Resolution Performance Measures

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10308 Parts C and D Complaints Resolution Performance Measures (CMS-10308)	Form and Instruction	Modified	Available
CR_OMB Supporting Statement B_130410_clean_FINAL.docx	Supporting Statement B	Uploaded 2013-07-25	Available
CROSSWALK - Changes to Advance Letter, Supporting Statements A and B, Survey Instrument, and Frequently Asked Questions.docx	Supplementary Document	Uploaded 2013-07-25	Available
6401 OMB Explanations for Inclusion of Survey Questions 100202.pdf	Supplementary Document	Uploaded 2013-07-25	Available
CMS- 10308 - Supporting Statement A [rev 7-25-2013 by OSORA PRA].docx	Supporting Statement A	Uploaded 2013-07-25	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
193233	Parts C and D Complaints Resolution Performance Measures (CMS-10308)	Form and Instruction	Modified

ICR Details

OMB Control No: 0938-1107	ICR Reference No: 201307-0938-021
Status: Historical Inactive	Previous ICR Reference No: 201208-0938-003
Agency/Subagency: HHS/CMS	Agency Tracking No: 20157
Title: Parts C and D Complaints Resolution Performance Measures
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Withdrawn and continue	Conclusion Date: 11/12/2013
	Date Received in OIRA: 07/30/2013
Terms of Clearance: Withdrawn with the consent of CMS. The program will be ending 12/31/13. This was unanticipated at the time this ICR was submitted. CMS will be submitting an emergency extension request shortly

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2013	36 Months From Approved	12/31/2013
Responses	5,300	0	5,300
Time Burden (Hours)	884	0	884
Cost Burden (Dollars)	0	0	0

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Abstract: The Complaints Resolution project will assist CMS in developing and supporting implementation of a plan performance measure that represents plan resolution of beneficiary complaints from the perspective of the beneficiaries themselves. Thus, the project includes development of methodologies for: 1.) identifying a statistically valid sample of beneficiary complaints needed to analyze the complaint's closure; 2.) contacting, interviewing, and summarizing beneficiary experience; and, 3.) summarizing/analyzing the resultant data to assess veracity of the resolution of beneficiary complaints from the perspective of the beneficiaries themselves via objective exploration of the beneficiary's complaint resolution experience.

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Authorizing Statute(s): EO: EO 13410 Name/Subject of EO: Promoting Quality and Efficient Health Care in Federal Government Administered
  

Citations for New Statutory Requirements: None

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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 26053	05/03/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 42957	07/18/2013
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Parts C and D Complaints Resolution Performance Measures (CMS-10308)	CMS-10308, CMS-10308	Complaints Resolution Survey (Spanish) ,   Complaints Resolution Survey (English)

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Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: We propose to survey all complaints in the universe instead of a sample from the universe. In 2013, CMS will begin collecting the data by primarily utilizing a web-based survey and supplemented on an ad hoc basis with a paper and pencil self-administered version. The inclusion of this mode of data collection - via a website - is an opportunity for CMS to reach out to more beneficiaries at a cost-effective ratio. The web-based survey will have the same per response burden to beneficiaries as the current data collection mechanisms (phone and paper). The original two modes of data collection (telephone and mail-in) included all the same questions and answer options as the web-based survey instrument. In 2013, the phone based survey has been dropped as the primary means of data collection in favor of the web-based survey. The sole difference between the modes is that FAQs will be available to beneficiaries completing the web-based survey. With the addition of the web-based survey and in order to bring the survey into alignment with the Plain Language Act (PLA), changes/revisions have been made to the survey materials--none of which impact currently approved burden estimates. A Crosswalk of those changes is included in this package.

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Annual Cost to Federal Government: $522,623

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]? No

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: 07/30/2013

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