Generic Clearance for Questionnaire Testing and Methodological Research for the Medicare Current Beneficiary Survey (MCBS) (CMS-10549)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10549.GenIC#3 Questionnaire	Form and Instruction	New	Available
Form CMS-10549.GenIC#3 Screening Instrument	Form	New	Repair queued
0519-MCBS.PDF	Supplementary Document	Uploaded 2018-05-11	Available
CMS-10549_Supporting_Statement_Part_A final-(5-11-18).docx	Supporting Statement A	Uploaded 2018-05-11	Available
Attachment #1 - CMS-10549.60-day FRN (82 FR 49816)-10-27-17.pdf	Supplementary Document	Uploaded 2018-01-24	Available
CMS-10549_Supporting_Statement_Part_B final.docx	Supporting Statement B	Uploaded 2018-01-24	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
239378	CMS-10549.GenIC #5: MCBS Testing Revisions to Advance Mailing Materials	Instruction	New
233732	CMS-10549.GenIC #4: MCBS Testing of Revised Advance Letter	Instruction	New
233217	CMS-10549.GenIC#3 - MCBS Cognitive Testing Self-Management Items	Form and Instruction	New	Questionnaire
233217	CMS-10549.GenIC#3 - MCBS Cognitive Testing Self-Management Items	Form	New	Screening Instrument

ICR Details

OMB Control No: 0938-1275	ICR Reference No: 201801-0938-008
Status: Historical Active	Previous ICR Reference No: 201508-0938-002
Agency/Subagency: HHS/CMS	Agency Tracking No: CMS/OEDA
Title: Generic Clearance for Questionnaire Testing and Methodological Research for the Medicare Current Beneficiary Survey (MCBS) (CMS-10549)
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 05/18/2018
Retrieve Notice of Action (NOA)	Date Received in OIRA: 01/24/2018
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2021	36 Months From Approved	05/31/2018
Responses	750	0	1,500
Time Burden (Hours)	558	0	1,117
Cost Burden (Dollars)	0	0	0

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Abstract: This OMB generic clearance request is for Medicare Current Beneficiary Survey (MCBS) Questionnaire Testing and Methodological Research. This request encompasses development and testing of MCBS questionnaires, instrumentation, as well as methodological experiments. The MCBS (OMB No. 0938-0568) is an in-person, nationally-representative, longitudinal survey of Medicare beneficiaries.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Research and investigations generally
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 49816	10/27/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 3154	01/23/2018
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
CMS-10549.GenIC #4: MCBS Testing of Revised Advance Letter
CMS-10549.GenIC #5: MCBS Testing Revisions to Advance Mailing Materials
CMS-10549.GenIC#3 - MCBS Cognitive Testing Self-Management Items	CMS-10549.GenIC#3 Attachment C, CMS-10549.GenIC#3 Attachment E	Screening Instrument ,   Questionnaire

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	750	1,500	0	-750	0	0
Annual Time Burden (Hours)	558	1,117	0	-559	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: We have conducted less generic information collection activities than we originally planned. We have reduced the number of respondents and have adjusted the requested burden allotment accordingly.

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Yes

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 01/24/2018

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