Recruitment script

EVALUATION OF COVERAGE TO CARE IN
COMMUNITIES
Appendix C
Recruitment Script for Partner Survey

(CMS-10632; OMB 0938-1342)
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 CMS-10632; OMB 0938-1342 (Expiration Date). The
time required to complete this information collection is estimated to average 20 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. *CMS Disclaimer* Please do not send applications, claims,
payments, medical records, or any documents containing sensitive information to the PRA
Reports Clearance Office. Please note that any correspondence not pertaining to the
information collection burden approved under the associated OMB control number listed
on this form will not be reviewed, forwarded, or retained.

OMB No.: CMS-10632; OMB 0938-1342
Expiration Date: (EXPIRATION DATE)
Dear [Name],
The Centers for Medicare & Medicaid Services (CMS) within the U.S. Department of Health and Human
Services (HHS) has contracted with the Pacific Institute for Research and Evaluation (PIRE) to conduct
an evaluation of From Coverage to Care (C2C). The goals of the study are to:
1) Determine why organizations use (or do not use) C2C materials;
2) Assess the impact and reach of C2C; and
3) Assess whether and how C2C improves consumer health literacy and care utilization.
More specifically, the purpose of the study is to better understand the dissemination and use of C2C; how
organizations use C2C materials/messages; how consumers use C2C materials/messages; and to what
extent C2C exposure predicts changes in outcomes, such as health insurance literacy and care utilization.
We would like to invite you to participate in an online survey about how your organization uses materials
that connect consumers with health care. Please note that we are interested in your participation even if
you have not seen or used C2C materials. For those who have used C2C materials, we are interested in
knowing how your organization uses them, what impact they may have had on staff or consumers, and
your recommendations for how to improve future C2C resources. For those who have not used C2C
materials, we are interested in learning about what health literacy informational resources you use. As a
thank you for participating, we will send you a gift card worth $35.
While your participation is voluntary, we do hope you will decide to contribute to this important study as
requested in the included letter from LaShawn McIver, Director of the CMS Office of Minority Health.

How You Can Help
1. Participate in the survey. The survey will last about 20 minutes. In order for our study to be
representative of the organizations in your community, we hope you will participate.
2. Identify other organizations in your community, similar to yours, that might benefit from using
C2C materials. As part of this project, we are interested in speaking to organizations that do not use
C2C materials to find out what materials or resources they use to serve consumers and learn about the
health information needs of those they serve. This will help C2C more carefully craft materials that
are helpful to all consumers. When asked, please indicate any organizations in your community,
similar to yours, that might not use C2C materials.

What Will Happen to the Information You Provide?
Your responses will be combined with others and reported together. At the end of the study, we will
destroy any information that identifies you as a participant, and identifiable information about you (e.g.,
name, organization name) will not be shared with anyone outside of the PIRE project staff without your
permission, except as required by law.

Contact
For more information about the study, contact (PIRE STUDY CONTACT TBD) ([email protected]).