Medicare Ombudsman Customer Service Feedback Survey (CMS-10068)

ICR 201512-0938-002

OMB: 0938-0894

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Supplementary Document
2015-12-08
Justification for No Material/Nonsubstantive Change
2015-12-08
Supplementary Document
2014-10-27
Supplementary Document
2014-10-27
Supporting Statement B
2014-10-27
Supporting Statement A
2014-10-27
IC Document Collections
ICR Details
0938-0894 201512-0938-002
Historical Active 201410-0938-015
HHS/CMS
Medicare Ombudsman Customer Service Feedback Survey (CMS-10068)
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 04/28/2016
Retrieve Notice of Action (NOA) 12/09/2015
  Inventory as of this Action Requested Previously Approved
11/30/2017 11/30/2017 11/30/2017
2,380 0 2,380
317 0 317
0 0 0

The Centers for Medicare and Medicaid Services stresses a continuing need for setting customer service goals that include providing accurate, timely, and relevant information to its customers. With these goals in mind, we periodically survey our customers to ensure that the needs of Medicare beneficiaries are being met. This survey will be used to measure overall satisfaction of the customer service that the Medicare Ombudsman Group (MOG) within CMS provides to Medicare beneficiaries and their representatives. The information provided will be used by management and staff to measure and improve the quality and timeliness of responses to written and verbal correspondence.

US Code: 42 USC 301 Name of Law: Public Health Service Act
  
None

Not associated with rulemaking

  79 FR 32963 06/09/2014
79 FR 56379 09/19/2014
Yes

1
IC Title Form No. Form Name
MEDICARE OMBUDSMAN CUSTOMER SERVICE FEEDBACK SURVEY CMS-10068 Medicare Ombudsman Customer Service Feedback Survey

  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 2,380 2,380 0 0 0 0
Annual Time Burden (Hours) 317 317 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$9,139
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.
12/09/2015


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