Beneficiaries

Appendix C3.
Telephone Survey Introduction

Script-English

I am calling on behalf of the Office of Medicare Hearings and Appeals within the U.S. Department of Health and Human Services. The purpose of my call is to ask some questions about your experience with the Medicare Administrative Law Judge hearing process to learn more about the level of customer service you received.

The Office of Medicare Hearings and Appeals has asked my firm, 2M Research, to administer the survey in order to keep your answers completely anonymous. We will not reveal your name, or other personal identifying information, with your responses to the survey or in any report to the government.

Do you have any questions for me before we begin the survey?

If you would like to make a comment about this survey or confirm that this is a valid collection of information, you may contact the Office of Medicare Hearings and Appeals Survey Team at 1-866-207-4466. I will repeat that number at the end of our phone call as well.

As we go through the survey, when we say “OMHA” we mean the Office of Medicare Hearings and Appeals.

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(to be included in internet version and read upon request for telephone version)

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0990-0330. The time required to complete this information collection is estimated to average 15 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Health & Human Services, OS/OCIO/PRA, 200 Independence Ave. SW, Suite 537-H, Washington, DC 20201, Attention: PRA Reports Clearance Officer.