Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

ICR 201506-0938-013

OMB: 0938-1185

Federal Form Document

Forms and Documents
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Name
Status
Form and Instruction
New
Form and Instruction
New
Form and Instruction
New
Form and Instruction
New
Form and Instruction
New
Form and Instruction
New
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Unchanged
Form
Unchanged
Form and Instruction
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Modified
Form and Instruction
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Form and Instruction
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Justification for No Material/Nonsubstantive Change
2015-06-26
Justification for No Material/Nonsubstantive Change
2014-12-17
Supplementary Document
2012-12-13
Supporting Statement B
2012-09-13
Supporting Statement A
2012-09-13
IC Document Collections
IC ID
Document
Title
Status
219259 New
219253 New
219033 New
218995 New
218801 New
218334 New
218155 New
216841 Unchanged
216680 Unchanged
216383 Unchanged
216236 Unchanged
215761 Unchanged
215707 Unchanged
214725 Unchanged
214407 Unchanged
214103 Modified
212695 Unchanged
212692 Unchanged
208331 Unchanged
207445 Unchanged
ICR Details
0938-1185 201506-0938-013
Historical Active 201412-0938-006
HHS/CMS
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 06/30/2015
Retrieve Notice of Action (NOA) 06/26/2015
Previous terms continue: OMB approves this collection for a period of three years. To request approval of information collections under this generic approval, the agency must do the following: 1) Unless an agency is using multiple modes of collection (e.g., paper forms and electronic submissions), provide a Generic Clearance Submission Template for each Instrument; 2) If the agency is using multiple modes of collection (e.g., paper forms and electronic submissions), the same Generic Clearance Submission Template may be used for both instruments; 3) each Generic Clearance Submission Template must be uploaded as a Supplementary document using a naming convention that allows the public to identify the associated instrument; 4) submit no more than five Generic Submission Templates with each request.
  Inventory as of this Action Requested Previously Approved
12/31/2015 12/31/2015 12/31/2015
1,000,000 0 1,000,000
25,000 0 25,000
0 0 0

This collection of information is necessary to enable the Agency to garner customer and stakeholder feedback in an efficient, timely manner, in accordance with our commitment to improving service delivery. The information collected from our customers and stakeholders will help ensure that users have an effective, efficient, and satisfying experience with the agency's programs. This feedback will provide insights into customer or stakeholder perceptions, experiences and expectations, provide an early warning of issues with service, or focus attention on areas where communication, training or changes in operations might improve delivery of products or services. These collections will allow for ongoing, collaborative and actionable communications between the Agency and its customers and stakeholders. It will also allow feedback to contribute directly to the improvement of program management.

EO: EO 12862 Name/Subject of EO: Setting Customer Service Standards
  
EO: EO 12862 Name/Subject of EO: Setting Customer Service Standards
EO: EO 13571 Name/Subject of EO: Streamlining Service Delivery and Improving Customer Service

Not associated with rulemaking

  75 FR 80542 12/22/2010
77 FR 31616 05/29/2012
No

20
IC Title Form No. Form Name
Evaluation of Stakeholder Training - Health Insurance Marketplace and Market Stabilization Programs 0938-1185 Stakeholder Training Forms
Development, Adaptation, Implementation, and Maintenance of Quality Measures for the Programs of All-Inclusive Care for the Elderly (PACE) (CMS-10557) CMS-10557 PACE Pilot Test Evaluation
Quality Reporting Process Survey (CMS-10562) CMS-10562 Quality Reporting Process Survey
(CMS-10560) Focus Groups to Inform the Development of a Marketplace Dental Survey CMS-10560 Focus Group Eligibility Screener, Consent form and Protocol
(CMS-10588) Usability Testing and Evaluation for Phase 1 of the QualityNet Portal (QNP) Redesign Project CMS-10588 Usability Test Script
(CMS-10590) QualityNet.org and QualityNet Secure Portal Customer Satisfaction and Task Prioritization Survey for Phase 1 of the QualityNet Portal (QNP) redesign project. CMS-10590 Quality Net User Survey
Medicare Part D Beneficiaries' Satisfaction on Potential Process Changes Associated With Comprehensive Medication Reviews (CMRs) and Targeted Medication Reviews (TMRs) (CMS-10396) CMS-10396 Telephone Interview Script
Development, Adaptation, Implementation, and Maintenance of Quality Measures for the Programs of All-Inclusive Care for the Elderly (PACE) (CMS-10557) CMS-10557 Pilot Test Registration Tool
(CMS-10585) QualityNet.org and QualityNet Secure Portal Customer Satisfaction and Task Prioritization Survey for Phase 1 of the QualityNet Portal (QNP) redesign project CMS-10585 Quality Net User Survey
End Stage Renal Disease (ESRD) Grievant Satisfaction Survey (IC#5) GenIC #5 ESRD Grievant
(CMS-10591) Cognitive Testing for the Marketplace Dental Survey CMS-10591 Marketplace Dental Survey Cognitive Testing Eligibility Screener
Instrument for Soliciting Feedback on Satisfaction With, and Changes to, the Standardized Format (Medication Therapy Management Program Improvements; CMS-10396, OMB No. 0938-1154) (GenIC#6) Beneficiary Telephone Interview Script CMS-10396
Peer Coach Assessment
(CMS-10546) Survey for Long-Term (LT) and Post-Acute Care (PAC) Electronic Health Records (EHR) and Health Information Exchange (HIE) Adoption CMS-10546 Utilization of Health Information Technology in Post-Acute Care Settings
Health Care Payment Learning and Action Network (CMS-10559) CMS-10559 Health Care Payment Learning and Action Network
Health Care Payment Learning and Action Network Registration (CMS-10584) CMS-10584 LAN Summit Registration Form
End Stage Renal Disease (ESRD) Grievant Satisfaction Survey (IC#5) - Round 2 GenIC#5 ESRD Greivant Satisfaction Survey
Beneficiary Contact Center Customer Satisfaction Survey CMS-10415 IVR Phone Script for Survey
Reporting for the Health Insurance Marketplace and Qualified Health Plan Enrollee Experience Surveys: Health Insurance Marketplace Consumer Experience Surveys Project CMS-10534 Cognitive Interview Guide, Screener and Consent Forms
Usability Testing for the Health Insurance Marketplace Websites: Health Insurance Marketplave Consumer Experiernce Surveys Project CMS-10533 Consumer Usability Testing Guide, and Screeners

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 1,000,000 1,000,000 0 0 0 0
Annual Time Burden (Hours) 25,000 25,000 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$217,200
Yes Part B of Supporting Statement
No
No
No
No
Uncollected
William Parham 4107864669

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
06/26/2015


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