Form CMS-10719 MACBIS Software Application Electronic Surveys for Users

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

Instrument_MACBIS Software Application Electronic Surveys for Users (version 3) CLEAN

MACBIS Software Application Electronic Surveys for Users (CMS-10719)

OMB: 0938-1185

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MACBIS Software Application Electronic Surveys for Users (Survey Instrument)


PRA Disclosure Statement 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 0938-1185 (CMS-10719). The time required to complete this information collection is estimated to average 5 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: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.



Question Title


* 1. Do you think <this CMS MACBIS software application> is useful for <CMS / State / Drug Manufacturer> interaction?

Shape1 I would not use this product

Shape2 I would not use this product.

Shape3 I would use this regularly.

Shape4 I believe this is valuable for someone else on our T-MSIS team.

Shape5 I believe this is valuable for Medicaid directors and other executives.

Shape6 It is helpful to see our state's data from CMS' perspective.

Shape7 I would like to see more personalized information about our state

Shape8 Other (please specify)



Question Title

* 2. What part of this new “feature” do you feel is most useful and why?

Note: this question will display in close placement to the new feature(s)



Question Title

* 3. What part of <this CMS MACBIS software application> do you feel is most useful and why?



Question Title

* 4. If you could build any feature you wanted on <this CMS MACBIS software application>, what would you want?



Question Title

* 5. Overall, how usable is <this CMS MACBIS software application>?

Shape9 Very easy

Shape10 Easy

Shape11 Neither easy nor difficult

Shape12 Difficult

Shape13 Very difficult





If participating in User Acceptance Testing



Question Title

* 1. Did you feel that you had complete documentation to do the testing? (Select all that apply)

Shape14 I would have preferred to have received the information earlier.

Shape15 The document provided was helpful for testing.

Shape16 The document provided was too complicated.

Shape17 I would have preferred more guidance about expectations. 

Shape18 The kickoff webinar was helpful in setting expectations. 

Shape19 The kickoff webinar was too time-consuming.

Shape20 Timelines were made clear.

Shape21 Timelines were unclear.

Other Comments



Question Title

* 2. Was there enough communication during UAT? (Select all that apply)

Shape22 I would have preferred a daily touch point.

Shape23 I would have preferred no kickoff meeting.

Shape24 CMS did not respond to my comments in a timely manner.

Shape25 CMS was responsive.

Shape26 I feel that my feedback was heard.

Shape27 My questions were answered.

Other Comments Shape28



Question Title

* 3. Do you think this new feature is useful?

Note: this question will display in close placement to the new feature(s)

Shape29 I would not use this product.

Shape30 I would use this regularly.

Shape31 I believe this is valuable for someone else on our team.

Shape32 I believe this is valuable for Medicaid directors and other executives.

Shape33 It is helpful to see our data from CMS' perspective.

Shape34 I would like to see more personalized information.

Shape35 Other Comments



Question Title

* 4. Thank you very much for participating in the <MACBIS software> UAT. Based on this experience... (Select all that apply)

Shape36 I enjoyed having a preview of the product and being able to give feedback.

Shape37 I would not want to participate in the future.

Shape38 It was too time consuming.

Shape39 I am interested in testing upcoming new features.

Shape40 Other Comments

Shape41













The following screenshots are to present look and feel of the electronic survey. Actual verbiage is documented in questions above.



File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorTinu Arowojolu
File Modified0000-00-00
File Created2021-01-15

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