0938-1185 Change Justification_ESRD Grievant Satisfaction Survey (6-2015)

1979 Marcus Avenue, Suite 105 • Lake Success, NY 11042-1072
Phone: 516-209-5253 • Fax: 516-326-7805 • [email protected]
www.esrdncc.org • www.kcercoalition.com

June 17, 2015
Non-Substantive Change Request to OMB CN 0938-1185
ESRD Grievant Satisfaction Survey
This is a non-substantive change request to the survey materials for the OMB-approved
ESRD Grievant Satisfaction Survey. Changes made to the pre-notification letter and
Question 2 and the branching for Question 3 of the survey questionnaire are as follows:
Pre-Notification Letter
• Updating the organization name to read “ESRD National Coordinating Center
(NCC)” rather than “ESRD Network Coordinating Center (NCC)” for consistency
with CMS-approved 2015 contract modification.
o IMPACT: Ensure consistency with 2015 ESRD NCC branding.
• Grammatical additions, i.e. “call you up to five times” and “call you between the
following dates”, to clarify the language.
• Replacing “[insert Network name]” to “the Network”.
o IMPACT: Keep the pre-notification letter to one page.
Survey Questionnaire
• Add Question 2A “Did your Network explain your right to file a grievance to you?”
o IMPACT: Reduce length of survey for respondents that may answer “No”.
• Remove “Did not understand at all (-1)” and “Network did not explain grievance
rights (-2)” from answer options for newly created Question 2B.
o IMPACT: Eliminate overuse of negative responses and ensure
consistency in Likert scale scoring, allowing for balanced measurement.
• Correct branching on pg. 4, such that a “Yes” answer for Question 3A directs to
Question 3B and a “No” answer for Questions 3A directs to Question 3C.
o IMPACT: Currently, survey respondents may be answering questions that
aren’t relevant.
Pre-Notification Letter and Survey Questionnaire
• Change in CMS contact, from Renée Dupee to Kathleen Egan, per CMS
direction.
• Addition of OMB CN and expiration date.
These changes have no impact on the burden associated with this collection. We are
currently receiving survey respondent contact information; thus, approval for these
corrections is needed quickly to ensure that our survey administrator can use the
updated versions of the pre-notification letter and survey questionnaire.

ESRD National Coordinating Center (NCC)
Non-Substantive Change to OMB CN 0938-1185

Version 1.0 • Revision Date: 06/18/2015
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