CMS-10068 (0938-0894) Non-Substantive Change Request

CMS-10068 (0938-0894) Non-SubstantiveChangeRequest (Dec 2015).docx

Medicare Ombudsman Customer Service Feedback Survey (CMS-10068)

CMS-10068 (0938-0894) Non-Substantive Change Request

OMB: 0938-0894

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Non-Substantive Change Request to CMS-10068


This package is currently approved. This is a non-substantive change request to Centers for Medicare and Medicaid Services (CMS) Medicare Ombudsman Customer Service Feedback Survey (CMS-10068) to allow CMS to measure overall satisfaction of the customer service that the Medicare Ombudsman Group (MOG) provides to Medicare beneficiaries and their representatives.


Senior management of the Office of Hearings and Inquiries (OHI) requested the group change all usage of the Office of the Medicare Ombudsman to Medicare Ombudsman Group. In alignment with this request, we are changing all usage of the Office of the Medicare Ombudsman on the survey.


Cara Vriezen replaced Nancy Conn as the senior project manager. Cara’s name and number are replacing Nancy’s for any questions about the survey.


We are also requesting a non-substantive change for the code after the CMS Form number from (01/11) to (12/14) on page 2 of the survey.


None of these requested non-substantive changes will affect the burden.


We are requesting approval of the non-substantive change request by January 1, 2016.



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