CMS-10068SupportingStatement-PartB

Supporting Statement – Part B
Collections of Information Employing Statistical Methods

1. This survey was created to obtain information from a sample of English and Spanish speaking
persons 65 years of age and older located in the U.S. and its territories regarding their opinions
about the service(s) the MOG provided. Specifically for this survey, the sample will be
approximately 595 persons per quarter. The annual sampling scheme has been selected to provide
a sample estimate of the population proportion that has a 95% confidence range. Previous similar
surveys conducted by the MOG during FY 2011-2012 and during FY 2012-2013 resulted in a 60%
response rate.
2. A mail survey of persons 65 years of age and older will be conducted quarterly. The sample
will consist of both English and Spanish speaking persons. To fulfill the purpose of the
justification, the degree of accuracy expected is of previous years’ response rates as noted in
above.
3. CMS sponsorship of the data collection added credibility and importance to the survey request.
There is also a telephone number listed on the survey for respondents to call and verify the
legitimacy of the survey. The survey is conducted in “real time;” meaning the survey is being
mailed out directly with responses creating a fast turnaround for responses and collection of data.
The survey also includes a postage paid return envelope that will also increase the response rate.
The survey is very short and does not require a lot of time for completion.
4. A pretest of the initial survey instrument was conducted both in English and Spanish to
determine if the instrument yielded the expected results found in the sampling plan. The sample
for each data set was nine respondents. See OMB 0938-0894
5. Ms. Nancy Conn and Ms. Cara Vriezen served as the Sampling Statisticians and developed
the Assessment of the MOG’s Customer Service for Written Correspondence Survey.

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