Beneficiary survey reminder letter

Attachment 6.e. Reminder Letter
DEPARTMENT OF HEALTH & HUMAN SERVICES
Centers for Medicare & Medicaid Services
7500 Security Boulevard, Mail Stop S1-13-05
Baltimore, Maryland 21244-1850
Month 2014
NAME
ADDRESS
CITY, STATE ZIP
Dear NAME:
About a month ago, we sent you a survey that the Centers for Medicare & Medicaid Services
(CMS) is doing called the Program Participant Survey. We have not gotten the survey back
from you yet. We are doing this survey to learn more about your experiences with the (Program
Name or Specific Program Name) program. If you have already sent us your survey, thank
you very much!
Please take a few minutes to answer the survey. Please return the survey in the envelope
included with this letter.
It is your choice whether or not to do the survey. Your decision will not affect your
Medicaid benefits. Your answers will be kept confidential and are protected by the Privacy Act.
We will not share your answers with (Program Name or Specific Program Name). We hope
that you will do the survey. Your answers will help us to make programs like this better.
Everyone who returns a survey can enter into a drawing for the chance to win a $50 gift card. If
you want to enter into the drawing, please complete and mail the enclosed postcard. On the
postcard, please write the name and address where you want the gift card sent (it is OK to use a
fake name or your initials). To protect your privacy, please mail the postcard separately from the
survey.
If you have any questions, please call NAME toll-free at 1-877-XXX-XXXX. Si desea recibir la
versión de la encuesta en español, por favor llame al 1-877- XXX-XXXX.
Thank you for your help with this survey.
Sincerely,

NAME
CMS TITLE

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