Implementation of the Medicare Prescription Drug Plan (PDP) and Medicare Advantage (MA) Plan Disenrollment Reasons Survey (CMS-10316)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10316 MA-PD Survey_Vietnamese	Form	Modified	Available
Form CMS-10316 MA-Only Survey_Vietnamese	Form	Modified	Available
Form CMS-10316 MA-Only Survey_Traditional Chinese	Form	Modified	Available
Form CMS-10316 MA-PD Survey_Traditional Chinese	Form	Modified	Available
Form CMS-10316 MAPD_Spanish	Form	Modified	Available
Form CMS-10316 MA Only_Spanish	Form	Modified	Available
Form CMS-10316 MA Only Survey	Form	Modified	Repair queued
Form CMS-10316 MA PD Survey	Form	Modified	Available
Form CMS-10316 Medicare Disenrollee Survey, Medicare Advantage (MA-PD and MA-Only)	Form	Modified	Repair queued
Form CMS-10316 Medicare Disenrollee Survey Prescriptopn Drug Plan (Vietnamese)	Form	Modified	Available
Form CMS-10316 Medicare Disenrollee Survey Prescriptopn Drug Plan (Chinese)	Form	Modified	Available
Form CMS-10316 Medicare Disenrollee Survey Prescriptopn Drug Plan (Spanish)	Form	Modified	Available
Form CMS-10316 Medicare Disenrollee Survey Prescriptopn Drug Plan	Form	Modified	Available
Form CMS-10316 Medicare Disenrollee Survey, Stand Alone Prescription Drug Plan (PDP) Version	Form	Modified	Repair queued
Supporting statement A_disenrollment survey_.docx	Supporting Statement A	Uploaded 2024-07-24	Repair queued
Supporting statement B_disenrollment survey.docx	Supporting Statement B	Uploaded 2024-07-12	Repair queued
Response to Public Comments_May 2024_final_clean.docx	Supplementary Document	Uploaded 2024-07-12	Repair queued
PDP Disenrollment Survey crosswalk_OMB_01.19.2024_508compliant.pdf	Supplementary Document	Uploaded 2024-07-12	Repair queued
MA-Only Disenrollment Survey crosswalk_OMB_01.19.2024_508compliant.pdf	Supplementary Document	Uploaded 2024-07-12	Repair queued
MA_PD Disenrollment Survey crosswalk_OMB_01.19.2024_508compliant.pdf	Supplementary Document	Uploaded 2024-07-12	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
207675	Medicare Disenrollee Survey, Medicare Advantage (MA-PD and MA-Only)	Form	Modified	MA-PD Survey_Vietnamese
207675	Medicare Disenrollee Survey, Medicare Advantage (MA-PD and MA-Only)	Form	Modified	MA-Only Survey_Vietnamese
207675	Medicare Disenrollee Survey, Medicare Advantage (MA-PD and MA-Only)	Form	Modified	MA-Only Survey_Traditional Chinese
207675	Medicare Disenrollee Survey, Medicare Advantage (MA-PD and MA-Only)	Form	Modified	MA-PD Survey_Traditional Chinese
207675	Medicare Disenrollee Survey, Medicare Advantage (MA-PD and MA-Only)	Form	Modified	MAPD_Spanish
207675	Medicare Disenrollee Survey, Medicare Advantage (MA-PD and MA-Only)	Form	Modified	MA Only_Spanish
207675	Medicare Disenrollee Survey, Medicare Advantage (MA-PD and MA-Only)	Form	Modified	MA Only Survey
207675	Medicare Disenrollee Survey, Medicare Advantage (MA-PD and MA-Only)	Form	Modified	MA PD Survey
207675	Medicare Disenrollee Survey, Medicare Advantage (MA-PD and MA-Only)	Form	Modified
194737	Medicare Disenrollee Survey, Stand Alone Prescription Drug Plan (PDP) Version	Form	Modified	Medicare Disenrollee Survey Prescriptopn Drug Plan (Vietnamese)
194737	Medicare Disenrollee Survey, Stand Alone Prescription Drug Plan (PDP) Version	Form	Modified	Medicare Disenrollee Survey Prescriptopn Drug Plan (Chinese)
194737	Medicare Disenrollee Survey, Stand Alone Prescription Drug Plan (PDP) Version	Form	Modified	Medicare Disenrollee Survey Prescriptopn Drug Plan (Spanish)
194737	Medicare Disenrollee Survey, Stand Alone Prescription Drug Plan (PDP) Version	Form	Modified	Medicare Disenrollee Survey Prescriptopn Drug Plan
194737	Medicare Disenrollee Survey, Stand Alone Prescription Drug Plan (PDP) Version	Form	Modified

ICR Details

OMB Control No: 0938-1113	ICR Reference No: 202407-0938-010
Status: Active	Previous ICR Reference No: 202304-0938-020
Agency/Subagency: HHS/CMS	Agency Tracking No: CM-CPC
Title: Implementation of the Medicare Prescription Drug Plan (PDP) and Medicare Advantage (MA) Plan Disenrollment Reasons Survey (CMS-10316)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 11/18/2024
Retrieve Notice of Action (NOA)	Date Received in OIRA: 07/25/2024
Terms of Clearance: Approved consistent with the understanding that the agency will update the race/ethnicity question in this information collection to be in compliance with the updated SPD 15 (effective as of March 28, 2024) by December 2027.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2027	36 Months From Approved	12/31/2024
Responses	36,050	0	32,750
Time Burden (Hours)	6,730	0	7,055
Cost Burden (Dollars)	0	0	0

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Abstract: This information collection will survey disenrollees from Medicare Prescription Drug Plans (PDPs) and Medicare Advantage Prescription Drug Plans (MA-PDs). The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) provides a requirement to collect and report performance data for Part D prescription drug plans. Specifically, the MMA under Sec. 1860D-4 (Beneficiary Protections for Qualified Prescription Drug Coverage) requires CMS to conduct consumer satisfaction surveys regarding PDPs and MA-PDs - pursuant to section 1860D-4(d). This data collection complements the satisfaction data collected through the Medicare CAHPS Survey by providing dissatisfaction data in the form of reasons for disenrollment from PDPs and MA-PDs.

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Authorizing Statute(s): Statute at Large: 1 Stat. 1860
  

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:
	89 FR 18411	03/14/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 57901	07/16/2024
Did the Agency receive public comments on this ICR? Yes

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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
Medicare Disenrollee Survey, Medicare Advantage (MA-PD and MA-Only)	CMS-10316, CMS-10316, CMS-10316, CMS-10316, CMS-10316, CMS-10316, CMS-10316, CMS-10316	MA PD Survey ,   MA Only Survey ,   MA Only_Spanish ,   MAPD_Spanish ,   MA-PD Survey_Traditional Chinese ,   MA-Only Survey_Traditional Chinese ,   MA-Only Survey_Vietnamese ,   MA-PD Survey_Vietnamese
Medicare Disenrollee Survey, Stand Alone Prescription Drug Plan (PDP) Version	CMS-10316, CMS-10316, CMS-10316, CMS-10316	Medicare Disenrollee Survey Prescriptopn Drug Plan ,   Medicare Disenrollee Survey Prescriptopn Drug Plan (Spanish) ,   Medicare Disenrollee Survey Prescriptopn Drug Plan (Chinese) ,   Medicare Disenrollee Survey Prescriptopn Drug Plan (Vietnamese)

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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	36,050	32,750	0	3,300	0	0
Annual Time Burden (Hours)	6,730	7,055	0	-325	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: Miscellaneous Actions

Short Statement: CMS proposes to delete eight items from the MA-PD survey; four items from the MA-only survey, and six items from the PDP survey to reduce respondent burden. The collections respondent and hourly burden has decreased from the last approved version.

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Annual Cost to Federal Government: $2,000,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

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: 07/25/2024

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