Change Justification_ESRD Grievant Satisfaction Survey (GenIC#5)

3000 Bayport Drive, Suite 300 - Tampa, FL 33607
Phone: 813-865-3535  Fax: 813-854-1514  [email protected]
www.esrdncc.org  www.kcercoalition.com

March 25, 2016
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 and Survey Questionnaire
 Change in CMS contact, from Kathleen Egan to Renee Dupee, per CMS
direction.
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 2.0  Revision Date: 03/25/2016
Page 1 of 1