Change Justification_ESRD Grievant Satisfaction Survey

3000 Bayport Drive, Suite 300 - Tampa, FL 33607
Phone: 813-865-3535 • Fax: 813-854-1514 • [email protected]
www.esrdncc.org • www.kcercoalition.com

February 7, 2019
Non-Substantive Change Request to OMB CN 0938-1185
ESRD Grievant Satisfaction Survey
This is a non-substantive change request for the OMB-approved ESRD Grievant Satisfaction Survey
currently posted and accessible on the Office of Information and Regulatory Affairs Office of Management
and Budget website https://www.Reginfo.gov Beginning March 1, 2019, the ESRD NCC and Grievance
Satisfaction Survey Administrator recommend the following changes to the ESRD Grievance Satisfaction
Survey and are seeking approval to modify the survey.
•
•
•
•
•
•

•

Q3C – The question is currently formatted for a yes/no answer instead of a scaling response. The
ESRD NCC seeks the following alternative: “After your conversation with the Network, did
someone who works with patients at your facility help you with your grievance?”
Q4 – The question is currently formatted for a yes/no answer instead of a scaling response. The
ESRD NCC seeks the following alternative: “How respected did you feel while the Network
processed your grievance?”
Q10 - The question is currently formatted for a yes/no answer instead of a scaling response. The
ESRD NCC seeks the following alternative: “How comfortable are you with the Network grievance
process to file another grievance?”
Currently questions 11-14 skip back and forth between the ESRD Network and the dialysis facility.
The ESRD NCC proposes to reorder the questions:
Prior to contacting the Network, did you attempt to file a grievance at your dialysis facility?
o Yes (next question)
o No (end survey)
When you attempted to file a grievance at your dialysis facility, did anyone at the facility ever try
to talk you out of filing a grievance?
o Yes
o No
o I prefer not to answer
o I did not file a grievance at the facility
If yes, what did they say to you?
When you filed a grievance at your dialysis facility, did you feel that the staff at your dialysis
facility took actions against you after you filed your grievance?
o Yes
o No
o prefer not to answer
o I did not file a grievance at the facility
If yes, how did the center take action against you?

This change request has no impact on the burden associated with this collection and only changes the
format or order of the questions. The content of the questions remains the same.
ESRD NCC Contact Information:
Julie Moss, MS
813-865-3125 / [email protected]

ESRD National Coordinating Center (NCC)
Non-Substantive Change to OMB CN 0938-1185

02112019
Page 1 of 1