PaRIS Advance Letter

Attach3_PaRIS_AdvLtr.pdf

Patient-Reported Indicator Survey (PaRIS) (CMS-10792)

PaRIS Advance Letter

OMB: 0938-1434

Document [pdf]
Download: pdf | pdf
[Month, Year]
[Mailing ID]
[Respondent Name]
[Respondent Address]
[Respondent City, State Zip]
Dear [Respondent Name]:
Within the next few weeks, a representative from our agency will contact you to ask
permission to interview you for a special one-time survey about your experiences with
healthcare services. The U.S. Centers for Medicare and Medicaid Services have selected you
to participate in this survey because of your recent participation in the Medicare Current
Beneficiary Survey (MCBS).
This special survey is being conducted all over the world to help policy makers better
understand how people around the world experience health care.
The representative who will contact you is from NORC at the University of Chicago. The
interview will take about 40 minutes and can be completed at a time convenient to you. If we
cannot reach you by phone, our representative may visit you in-person to conduct the
interview. This person will have identification showing they are a representative for this
Medicare survey.
Your participation in this special survey is your choice. Your Medicare benefits cannot be
affected in any way by your decision to participate or the answers you provide, and your
information will be kept private to the extent permitted by law, as prescribed by the Federal
Privacy Act of 1974.
If you have any questions, please call NORC toll-free at 1-844-777-2151, or email
[email protected]. To set an appointment for your interview, please call or email us.
I hope you’ll be able to help us with this important project to improve healthcare services.

Marina Vornovitsky, Director
Medicare Current Beneficiary Survey
Centers for Medicare & Medicaid Services

OMB No. 0938-XXXX, expiration date: XX/XX/XXXX


File Typeapplication/pdf
File TitleHHS Community Advance Letter
SubjectMCBS
AuthorNORC
File Modified2021-11-01
File Created2021-11-01

© 2024 OMB.report | Privacy Policy