Application to Use Burden/Hours from Generic PRA Clearance:
Medicaid and CHIP State Plan, Waiver, and Program Submissions
(CMS-10398, OMB 0938-1148)
Information Collection #44 Oral Health Initiative, Customer Satisfaction Survey Tool
September 1, 2015
Center for Medicaid and CHIP Services (CMCS)
Centers for Medicare & Medicaid Services (CMS)
The Centers for Medicare & Medicaid Services (CMS) work in partnership with States to implement Medicaid and the Children’s Health Insurance Program (CHIP). Together these programs provide health coverage to millions of Americans. Medicaid and CHIP are based in Federal statute, associated regulations and policy guidance, and the approved State plan documents that serve as a contract between CMS and States about how Medicaid and CHIP will be operated in that State. CMS works collaboratively with States in the ongoing management of programs and policies, and CMS continues to develop implementing guidance and templates for States to use to elect new options available as a result of the Affordable Care Act or to comply with new statutory provisions. CMS also continues to work with States through other methods to further the goals of health reform, including program waivers and demonstrations, and other technical assistance initiatives.
This GenIC request supplements our CMS-416 package by adding an evaluation tool to better understand customer satisfaction with the package’s training modules. Entitled, “Annual Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Participation Report,” the CMS-416 package is approved under control number 0938-0354.
CMS produced six Form CMS-416 Dental Data Reporting web-based learning modules that aim to improve the quality of the data reported by states on the Form CMS-416. The survey tool is a vehicle to gauge user satisfaction of the learning modules.
Participation in the survey is voluntary; responses will support efforts to improve the learning modules in a manner that support state Medicaid staff in reporting standardized, accurate, and complete data on the Form CMS-416.
Based on the feedback received through the evaluation, there may be a need to make modifications to the web-based learning modules to improve their usefulness in achieving the intended goals.
The collected information will not be subject to any statistical analyses.
No deviations are requested with respect to ongoing reporting. As discussed above, this collection supports the reporting of information under CMS-416 in addition to the training modules that were recently approved in the CMS-416 package.
The total approved burden ceiling of the generic ICR is 154,104 hours, and CMS previously requested to use 67,279 hours, leaving our burden ceiling at 86,825 hours.
Wage Estimate
To derive average costs, we used data from the U.S. Bureau of Labor Statistics’ May 2014 National Occupational Employment and Wage Estimates for all salary estimates (http://www.bls.gov/oes/current/oes_nat.htm). In this regard, the following table presents the mean hourly wage, the cost of fringe benefits (calculated at 100 percent of salary), and the adjusted hourly wage.
Occupation Title |
Occupation Code |
Mean Hourly Wage ($/hr) |
Fringe Benefit ($/hr) |
Adjusted Hourly Wage ($/hr) |
Computer and Information Analyst |
15-1120 |
42.25 |
42.25 |
84.50 |
As indicated, we are adjusting our employee hourly wage estimates by a factor of 100 percent. This is necessarily a rough adjustment, both because fringe benefits and overhead costs vary significantly from employer to employer, and because methods of estimating these costs vary widely from study to study. Nonetheless, there is no practical alternative and we believe that doubling the hourly wage to estimate total cost is a reasonably accurate estimation method.
Burden Estimate
Based upon CMS’s experiences with rate setting, we estimate that on average it will take a respondent 15 minutes to complete one survey. There is a potential of 56 responses, one response per respondent is expected. We estimate that 56 surveys will be submitted for a total burden of 14 hours (56 surveys * .25 hours).
We anticipate that a Computer and Information Analyst will complete the survey and estimate a cost of $21.13 (per respondent) or $1,183 (aggregate).
CMS hopes to deploy this collection in September 2015.
The following attachment is provided for this information collection:
Customer Satisfaction Tool for Evaluating Form CMS-416 Web-Based Training Modules
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | CMS |
| File Modified | 0000-00-00 |
| File Created | 2021-01-26 |