CMS Tribal LTSS Program Survey

Follow-up Phone Script
Good [Morning/Afternoon].
My name is [NAME] and I’m calling from Kauffman & Associates, Inc. a native-owned company,
on behalf of the Center for Medicare and Medicaid Services (CMS) about the Tribal LTSS
Program Survey. The purpose of this survey is to obtain information to help in the development
of a list of tribally operated long-term services and supports (LTSS) programs across Indian
Country. The survey was sent to tribes and tribal programs on (XX date).
We are approaching the deadline for survey participation, and unfortunately your Tribe/tribal
program has not yet sent in their response. We want to make sure your Tribe’s LTSS program
information is included. To make sure we can highlight your program, would you be willing to
go over the questions with me now while we’re on the phone? The survey is short, with yes/no
questions, and should only take about 10 to 15 minutes to complete.

If “No,”:
i.

ii.

iii.

Set up a time to speak with/obtain the answers;
a. This may or may not be with the contact currently on the phone. If you are
directed to a different individual, make note of the contact’s information in a
tracker sheet.
Ask for the appropriate contact email or fax information to resend the survey;
a. If they are willing to complete the survey if it is resent, ask the contact for the
most accurate email or fax number to send the survey.
Establish if the tribe is withdrawing from the survey;
a. If this is the case, thank the contact for his/her time. Be sure to include the
contact’s name/title and reason for withdrawing in the tracker sheet.

Thank you for taking the time to talk with me. We look forward to receiving your Tribe’s
responses. If you have any questions, please feel free to contact me at (insert phone number)
or (insert email address).
Have a great day. Good-bye.