CMS-10437.GenIC#14.Supporting Statement

Application to Use Burden/Hours from Generic PRA Clearance:

Generic Social Marketing & Consumer Testing Research

(CMS-10437, OMB 0938-1247)

Generic Information Collection (GenIC) # 14: Medicare Beneficiary Consumer Survey

Office of Communications (OC)

Centers for Medicare & Medicaid Services (CMS)

A. Background

The Office of Communications/Strategic Marketing Group/Division of Research will be conducting a survey of Medicare beneficiaries. Survey respondents will be generally representative of the diverse population of audiences/customers that are served by the Medicare program. The survey will measure consumer perceptions and experiences related to their Medicare and health insurance decisions. The survey is designed and organized into several sections: health insurance status, health status, behaviors, perceptions, and demographics. The survey is brief -- time to complete the survey is expected to be approximately 15 minutes. The main goal of the survey will be to characterize individuals that participate in Medicare, their knowledge and awareness of key benefits, and their use of various consumer tools that Medicare has provided to support their informed decision making. This data will help to identify areas for continuous quality improvement in our information dissemination and communication activities. Results of the survey will be shared with CMS stakeholders and used to improve the web portal and other communication-related activities.

B. Description of Information Collection

This survey will be conducted on an ongoing basis. For each fielding of the survey, data will be professionally collected using mixed mode methodology that combines an online questionnaire [n = 900] and a telephone survey [n = 300]. Eligible participants will be invited to participate and will have the opportunity to opt-out.

Individual respondents are expected to spend an average of fifteen (15) minutes completing the survey.

No incentives will be offered for completing the survey.

Items will be drawn from the generic item pool and formatted for internet presentation. The survey will include: SG1, ING1, DG2, HSG1, ING2, ING9, ING6, ING7a,b,c, BP1, ISG1a, BG10a, ISG3a, ISG3b, ISG1b, AWG7a, BG10b, ISG1c, AWG7b, BG10c, ISG1d, AWG7c, AWG7d, BG10d, ISG1e, AWG7e, BG10e, ISG1f, ISG2, ISG6. PG9, PG7, PG6, BG3, KG7,HSG3, HSG2, IUG4, IUG21, AWG7f, ISG1g, AWG7g, BG10f, BG10g, ISG1g, BG8a, BG8a, AWG7h, BG10h, AWG2a, BG10i, BG10j, PG8, DG12, DG13, DG1, DG5, DG3, DG4, DG6, DG10

C. Deviations from Generic Request

None

D. Burden Hour Deduction

4,800 participants * 0.25 hours = 1,200 hours

E. Timeline

Data collection will begin when OMB approval is received and will be ongoing until burden hours are reached.

The following attachments are provided for this information collection:

Study Initiation Request Form (Medicare Beneficiary Consumer Survey)

Survey Instrument – Medicare Beneficiary Consumer Survey Instrument