Evaluating Coverage to Care in Communities (CMS-10632)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10632 Case Study: Explanation of Consent, Short Survey, and Focus Group Facilitation Guide	Form and Instruction	Removed	Repair queued
Form CMS-10632 Case Study: Focus Group	Form and Instruction	Removed	Repair queued
Form CMS-10632 Appendix C - Case Study Explanation of Consent and Semi-Structured Interview	Form and Instruction	Removed	Repair queued
Form CMS-10632 Case Study: Semi-structured Interviews	Form and Instruction	Removed	Repair queued
Form CMS-10632 Appendix B Consumer Survey: Informed Consent and Survey	Form and Instruction	Modified	Available
Form CMS-10632 Consumer Survey	Form and Instruction	Modified	Repair queued
Form CMS-10632 Appendix A - Partner Survey: Informed Consent and Survey	Form and Instruction	Modified	Repair queued
Form CMS-10632 Partner Survey	Form and Instruction	Modified	Repair queued
CMS-10203 Supporting Statement A.docx	Supporting Statement A	Uploaded 2021-05-07	Repair queued
CMS-10632_Supporting_Statement_B_.docx	Supporting Statement B	Uploaded 2021-05-06	Repair queued
CMS-10632.Appendix_E_Survey_Changes_srs_022221.pdf	Supplementary Document	Uploaded 2021-05-06	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
226371	Case Study: Focus Group	Form and Instruction	Removed	Case Study: Explanation of Consent, Short Survey, and Focus Group Facilitation Guide
226371	Case Study: Focus Group	Form and Instruction	Removed
226370	Case Study: Semi-structured Interviews	Form and Instruction	Removed	Appendix C - Case Study Explanation of Consent and Semi-Structured Interview
226370	Case Study: Semi-structured Interviews	Form and Instruction	Removed
226369	Consumer Survey	Form and Instruction	Modified	Appendix B Consumer Survey: Informed Consent and Survey
226369	Consumer Survey	Form and Instruction	Modified
226367	Partner Survey	Form and Instruction	Modified	Appendix A - Partner Survey: Informed Consent and Survey
226367	Partner Survey	Form and Instruction	Modified

ICR Details

OMB Control No: 0938-1342	ICR Reference No: 202105-0938-002
Status: Historical Active	Previous ICR Reference No: 201704-0938-003
Agency/Subagency: HHS/CMS	Agency Tracking No: OMH
Title: Evaluating Coverage to Care in Communities (CMS-10632)
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 09/01/2022
Retrieve Notice of Action (NOA)	Date Received in OIRA: 05/07/2021
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2025	36 Months From Approved
Responses	460	0	0
Time Burden (Hours)	152	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Achieving better health and reducing health care costs requires individuals to take an active role in their health care and utilize primary and preventive care services. CMS OMH launched C2C in June 2014 to address these needs. To accomplish these goals, C2C offers a variety of consumer-oriented health and health insurance educational materials that have various distribution channels, including print and digital. An evaluation was previously conducted under this OMB number assessing the reach and use of these materials. The current reinstatement proposal seeks to extend this work with a smaller survey of consumers (N=400) and partner organizations (N=60) to compare those who do and do not use C2C materials in three to four geographic areas where there is a high saturation of C2C materials, as well as the health impacts of using these materials.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 . Name of Law: Affordable Care 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:
	86 FR 12192	03/02/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 24624	05/07/2021
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Case Study: Focus Group	CMS-10632	Case Study: Explanation of Consent, Short Survey, and Focus Group Facilitation Guide
Case Study: Semi-structured Interviews	CMS-10632	Appendix C - Case Study Explanation of Consent and Semi-Structured Interview
Consumer Survey	CMS-10632	Appendix B Consumer Survey: Informed Consent and Survey
Partner Survey	CMS-10632	Appendix A - Partner Survey: Informed Consent and Survey

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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	460	0	0	436	-36	60
Annual Time Burden (Hours)	152	0	0	134	-36	54
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The research activities proposed for reinstatement are a subset of, and similar to, the previously approved activities; however, the proposed activities are smaller in scope. The previously approved activities included two case studies (semi-structured interview and focus group), while the activities proposed for reinstatement only consist of the partner and consumer surveys. Also, a smaller number of survey participants are proposed for the partner (600 vs. 60) and consumer (2800 vs. 400) surveys. The average burden is 20 minutes for all surveys. Following from the proposed activities representing a smaller number of surveys and the same burden hours per survey, survey costs were much higher for the prior partner ($12,117.60 vs. $1001.29) and consumer ($35,610 vs. $4,262.28) surveys.

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Annual Cost to Federal Government: $87,714

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? Yes

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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: 05/07/2021

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