SHIP-SMP Survey of One-on-One Assistance

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
SHIP-SMP Survey of One-on-One Assistance	Form and Instruction	Modified	Available
0056 Supporting Statement Part B.docx	Supporting Statement B	Uploaded 2020-06-24	Available
0057 Supporting Statement (1 on 1 Assistance) FINAL.docx	Supporting Statement A	Uploaded 2020-06-24	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
225703	SHIP-SMP Survey of One-on-One Assistance	Form and Instruction	Modified

ICR Details

OMB Control No: 0985-0057	ICR Reference No: 202006-0985-004
Status: Active	Previous ICR Reference No: 201702-0985-002
Agency/Subagency: HHS/ACL	Agency Tracking No:
Title: SHIP-SMP Survey of One-on-One Assistance
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/27/2020
	Date Received in OIRA: 06/25/2020
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2023	36 Months From Approved	08/31/2020
Responses	800	0	1,350
Time Burden (Hours)	80	0	180
Cost Burden (Dollars)	0	0	0

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Abstract: Abstract (2000 characters maximum) The SHIP-SMP Survey of One-on-One Assistance, formerly the National Beneficiary Survey of State Health Insurance Assistance Program (SHIP) will gauge individuals’ satisfaction with the services they receive from the State Health Insurance Assistance (SHIP) and Senior Medicare Patrol (SMP) Programs. The survey will be the first of its kind to ascertain the quality and effectiveness of the services provided by the SHIP and SMP and to determine if beneficiaries are receiving accurate, relevant and timely information. The survey will be conducted over a three-year period with multiple sites in each of the 50 states and the territories of Guam, Puerto Rico and the Virgin Islands being surveyed once. The SHIP program satisfaction survey will be conducted on a sample of beneficiaries who received assistance/counseling during two points in the year (one week in the spring and one week during the Annual Medicare Open Enrollment Period). The SMP program satisfaction survey will focus on education session presentations to determine if the target audience is satisfied with the information they are receiving. The results from these surveys will be used to measure satisfaction among individuals who receive assistance/counseling or among individuals who attend SMP education sessions, as well, as how the program can be improved to provide better service to its target population. The information obtained from this survey will be used by federal and regional employees of the Administration for Community Living (ACL), part of the Department of Health and Human Services. Specifically, the information will be used to assess customer satisfaction with one on one assistance services delivered by ACL’s SHIP and SMP programs. The results of the survey will be used to assess the need for overall agency improvements, including the reallocation of resources, revisions to certain agency processes and policies, and/or development of guidance related to the agency’s customer services. The results of the survey could also lead to improvements for individual Medicare beneficiaries, as improved customer service by the agency will lead to more appropriate Medicare choices for individual citizens, leading to monetary savings for both the individual and the SHIP/SMP program. Ultimately, these changes should improve the services ACL provides to the public.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Public Health Service Act
  

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 71956	12/30/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 37949	06/24/2020
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
SHIP-SMP Survey of One-on-One Assistance	NA	SHIP-SMP Survey of One-on-One Assistance

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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	800	1,350	0	0	-550	0
Annual Time Burden (Hours)	80	180	0	-100	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: Cutting Redundancy

Short Statement: The revised survey collection focuses on an annual, national survey of 800 response per year. The previous version of this survey required each state/territory to collect 75 responses once every three years, resulting in an average annual response total of 1,350 responses. There is a program change of -100 annual burden hours and an adjustment decrease of -550 annual responses. This change both reduces the annual survey burden while also allowing ACL to monitor overall programmatic progress on an annual basis.

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Annual Cost to Federal Government: $166,866

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]? No

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? No

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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: 06/25/2020

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