CMS-10068 (0938-0894) Survey 2016 Crosswalk

Revisions to CMS-10068 Medicare Ombudsman Customer Service Feedback Survey

Issue #	Section	Action to be performed	Changes	Reason for the Change
	(Section 1: Letter from Walter Stone)	Revise as follows:	Replace: 12 pt Times New Roman With: 13 pt Times New Roman	Revised to make survey easier to read.
	(Section 1: Letter from Walter Stone) 1st Paragraph, 4th Sentence	Revise as follows:	Replace: Enclosed is the Office of the Medicare Ombudsman’s response to your request. With: Enclosed is the response to your request from a Medicare Ombudsman Representative within the Medicare Ombudsman Group.	Revised for clarification purposes and to remove “Office of Medicare Ombudsman”.
	(Section 1: Letter from Walter Stone) 2nd Paragraph, 1st Sentence	Revise as follows:	Replace: Office of the Medicare Ombudsman provides With: Medicare Ombudsman Representatives provide	Revised for clarification purposes and to remove “Office of Medicare Ombudsman”.
	(Section 1: Letter from Walter Stone) 3rd Paragraph, 1st Sentence	Revise as follows:	Replace: our With: their	Revised for clarification purposes.
	(Section 1: Letter from Walter Stone) 3rd Paragraph, 1st Sentence	Revise as follows:	Replace: Office of the Medicare Ombudsman With: Medicare Ombudsman Representative	Revised to remove “Office of Medicare Ombudsman”.
	(Section 1: Letter from Walter Stone) 4th Paragraph, 1st Sentence	Revise as follows:	Replace: won’t With: will not	Revised to remove contraction.
	(Section 1: Letter from Walter Stone) 4th Paragraph, 2nd Sentence	Revise as follows:	Replace: Office of the Medicare Ombudsman responds With: Medicare Ombudsman Representatives respond	Revised for clarification purposes and to remove “Office of Medicare Ombudsman”.
	(Section 1: Letter from Walter Stone) 5th Paragraph, 1st Sentence	Revise as follows:	Replace: you may contact Nancy Conn of the Office of the Medicare Ombudsman toll-free at 1-877-267-2323 ext. 68374 With: you may contact Cara Vriezen toll-free at 1-877-267-2323 ext. 65695	Revised for clarification purposes and to remove “Office of Medicare Ombudsman”.
	(Section 1: Letter from Walter Stone) 6th Paragraph, 1st Sentence	Revise as follows:	Replace: Office of the Medicare Ombudsman’s With: Medicare Ombudsman Representative’s	Revised for clarification purposes and to remove “Office of Medicare Ombudsman”.
	(Section 2: Instructions) Title	Revise as follows:	Replace: MEDICARE OMBUDSMAN CUSTOMER SERVICE FEEDBACK SURVEY With: Medicare Ombudsman Representative Customer Service Feedback Survey	Revised for clarification purposes and spacing concerns.
	(Section 2: Instructions) 1st Paragraph, 1st Sentence	Revise as follows:	Replace: This survey is to measure your satisfaction with the customer service ________________ provided from the Office of the Medicare Ombudsman only (not Social Security, 1-800-MEDICARE or any other agency or department, please). With: This survey is to measure your satisfaction with the customer service provided by the Medicare Ombudsman Representative, ________________, (not Social Security, 1-800-MEDICARE or any other agency or department, please).	Revised for clarification purposes and to remove “Office of Medicare Ombudsman”.
	(Section 4: Additional Questions) Question #1	Revise as follows:	Replace: We welcome any suggestions to improve customer service provided by the Office of the Medicare Ombudsman: With: We welcome any suggestions to improve customer service provided by the Medicare Ombudsman Representative:	Revised for clarification purposes and to remove “Office of Medicare Ombudsman”.

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