Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (CMS-10415)

Forms and Documents

Document Name	Status
Form CMS-10726 CMS-10726 Survey Refinement for the Qualified Health Plan Enrollee Experience Survey Form and Instruction	New
Form CMS-10720 Medicare Administrative Contractor (MAC) Provider Customer Experience (CMS-10720) Form and Instruction	New
Form CMS-10719 MACBIS Software Application Electronic Surveys for Users (CMS-10719) Form	New
Form CMS-10415.GenIC #5 End Stage Renal Disease Grievant Satisfaction Survey Form and Instruction	New
Form CMS-10682 Unmoderated Online User Testing of a Proposed New CMS.gov Website Structure (CMS-10682) Form	New
Form CMS-10679 Electronic Medical Documentation Interoperability (EMDI) Workgroup Survey (CMS-10679) Form and Instruction	New
Form CMS-10676 Medicare.gov Sitewide Qualtrics (CMS-10676) Form and Instruction	New
Form CMS-10415 Medicaregov - Medicare Plan Finder Survey Form and Instruction	New
Form CMS-10415 CMS.gov User Satisfaction Survey Form and Instruction	New
Form CMS-10626 End Stage Renal Disease Quality Reporting System (EQRS) Customer Satisfaction and Task Prioritization Survey for the EQRS Release 1.0 Project (CMS-10626) Form and Instruction	New
Form CMS-10590 QualityNet.org and QualityNet Secure Portal Customer Satisfaction and Task Prioritization Survey for Phase 1 of the QualityNet Portal (QNP) redesign project (CMS- 10590) Form and Instruction	New
Form CMS-10588 Usability Testing and Evaluation for Phase 1 of the QualityNet Portal (QNP) Redesign Project (CMS-10588) Form and Instruction	New
Form CMS-10534 Reporting for the Health Insurance Marketplace and Qualified Health Plan Enrollee Experience Surveys: Health Insurance Marketplace Consumer Experience Surveys (CMS-10534) Form and Instruction	New
Form CMS-10415 Evaluation of Stakeholder Training - Health Insurance Marketplace and Market Stabilization Programs Form and Instruction	New
Form CMS-10415 Beneficiary Contact Center Customer Satisfaction Survey Form and Instruction	New
CMS-10415_Supporting Statement A - FINAL 10-8-19.docx Supporting Statement A	2019-10-08
CMS-10415_Supporting_Statement_Part_B 2019.doc Supporting Statement B	2019-04-29

IC Document Collections

IC ID	Document Title	Status
240090	CMS-10726 Survey Refinement for the Qualified Health Plan Enrollee Experience Survey Form and Instruction	New
238682	Medicare Administrative Contractor (MAC) Provider Customer Experience (CMS-10720) Form and Instruction	New
238454	MACBIS Software Application Electronic Surveys for Users (CMS-10719) Form	New
235903	End Stage Renal Disease Grievant Satisfaction Survey Form and Instruction	New
235902	Unmoderated Online User Testing of a Proposed New CMS.gov Website Structure (CMS-10682) Form	New
235900	Electronic Medical Documentation Interoperability (EMDI) Workgroup Survey (CMS-10679) Form and Instruction	New
235899	Medicare.gov Sitewide Qualtrics (CMS-10676) Form and Instruction	New
235898	Medicaregov - Medicare Plan Finder Survey Form and Instruction	New
235897	CMS.gov User Satisfaction Survey Form and Instruction	New
235896	End Stage Renal Disease Quality Reporting System (EQRS) Customer Satisfaction and Task Prioritization Survey for the EQRS Release 1.0 Project (CMS-10626) Form and Instruction	New
235895	QualityNet.org and QualityNet Secure Portal Customer Satisfaction and Task Prioritization Survey for Phase 1 of the QualityNet Portal (QNP) redesign project (CMS- 10590) Form and Instruction	New
235894	Usability Testing and Evaluation for Phase 1 of the QualityNet Portal (QNP) Redesign Project (CMS-10588) Form and Instruction	New
235891	Reporting for the Health Insurance Marketplace and Qualified Health Plan Enrollee Experience Surveys: Health Insurance Marketplace Consumer Experience Surveys (CMS-10534) Form and Instruction	New
235888	Evaluation of Stakeholder Training - Health Insurance Marketplace and Market Stabilization Programs Form and Instruction	New
235885	Beneficiary Contact Center Customer Satisfaction Survey Form and Instruction	New

ICR Details

OMB Control No: 0938-1185	ICR Reference No: 201904-0938-017
Status: Active	Previous ICR Reference No: 201611-0938-004
Agency/Subagency: HHS/CMS	Agency Tracking No: OC
Title: Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (CMS-10415)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 11/05/2019
	Date Received in OIRA: 04/30/2019
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2022	36 Months From Approved	11/30/2019
Responses	1,000,000	0	1,000,000
Time Burden (Hours)	50,000	0	50,000
Cost Burden (Dollars)	0	0	0

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Abstract: This collection of information is necessary to enable the Agency to garner customer and stakeholder feedback in an efficient, timely manner, in accordance with our commitment to improving service delivery. The information collected from our customers and stakeholders will help ensure that users have an effective, efficient, and satisfying experience with the agency's programs. This feedback will provide insights into customer or stakeholder perceptions, experiences and expectations, provide an early warning of issues with service, or focus attention on areas where communication, training or changes in operations might improve delivery of products or services. These collections will allow for ongoing, collaborative and actionable communications between the Agency and its customers and stakeholders. It will also allow feedback to contribute directly to the improvement of program management.

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Authorizing Statute(s): EO: EO 12862 Name/Subject of EO: Setting Customer Service Standards
  

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:
	84 FR 7063	03/01/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 18289	04/30/2019
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 15

IC Title	Form No.	Form Name
Medicaregov - Medicare Plan Finder Survey	CMS-10415	Medicaregov - Medicare Plan Finder Survey
MACBIS Software Application Electronic Surveys for Users (CMS-10719)	CMS-10719	MACBIS Software Application Electronic Surveys for Users
QualityNet.org and QualityNet Secure Portal Customer Satisfaction and Task Prioritization Survey for Phase 1 of the QualityNet Portal (QNP) redesign project (CMS- 10590)	CMS-10590	QualityNetPortal_UserSurvey
End Stage Renal Disease Quality Reporting System (EQRS) Customer Satisfaction and Task Prioritization Survey for the EQRS Release 1.0 Project (CMS-10626)	CMS-10626	CrownWeb Facility User Survey
Electronic Medical Documentation Interoperability (EMDI) Workgroup Survey (CMS-10679)	CMS-10679	EMDI_Workgroup_Participation_Survey
CMS-10726 Survey Refinement for the Qualified Health Plan Enrollee Experience Survey	CMS-10726, CMS-10726, CMS-10726	Consumer and Issuer Recruitment Language ,   Consent Forms ,   Descripton of Focus Groups and Cognitive Testing Protocols
Beneficiary Contact Center Customer Satisfaction Survey	CMS-10415	IVR Phone Script
Evaluation of Stakeholder Training - Health Insurance Marketplace and Market Stabilization Programs	CMS-10415	Evaluation of Stakeholder Training
End Stage Renal Disease Grievant Satisfaction Survey	CMS-10415.GenIC #5	End Stage Renal Disease (ESRD) Grievant Satisfaction Survey
Medicare.gov Sitewide Qualtrics (CMS-10676)	CMS-10676	Medicare.gov Sitewide Qualtrics Survey
CMS.gov User Satisfaction Survey	CMS-10415	CMS.gov User Satisfaction Survey
Reporting for the Health Insurance Marketplace and Qualified Health Plan Enrollee Experience Surveys: Health Insurance Marketplace Consumer Experience Surveys (CMS-10534)	CMS-10534	Cognitive Interview Guide, Screener and Consent Forms
Unmoderated Online User Testing of a Proposed New CMS.gov Website Structure (CMS-10682)	CMS-10682	CMS-10682.CMS_OCS_TestingQuestions_SitemapTesting
Medicare Administrative Contractor (MAC) Provider Customer Experience (CMS-10720)	CMS-10720, CMS-10720, CMS-10720, CMS-10720	Overall Website Feedback Survey.docx ,   Final Overall Portal Feedback Survey (Spanish) ,   Final Overall Website Feedback Survey (Spanish).docx ,   Final Overall Portal Feedback Survey.docx
Usability Testing and Evaluation for Phase 1 of the QualityNet Portal (QNP) Redesign Project (CMS-10588)	CMS-10588	Usability Test Script

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ICR Summary 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	1,000,000	1,000,000	0	0	0	0
Annual Time Burden (Hours)	50,000	50,000	0	0	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: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $250,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

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: 04/30/2019

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