Document
Medicare Advantage Beneficiary Customer Satisfaction Survey for Complaint Resolution
ICR 202609-0938-011 · OMB 0938-1382 · Object 172936500.
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Document Metadata
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
|---|---|
| File Title | Medicare Advantage Beneficiary Customer Satisfaction Survey for Complaint Resolution |
| Author | python-docx |
| Last Modified By | Writer |
| File Modified | 2026-06-16 |
| File Created | 2026-10-10 |
| Conversion State | complete |
Extracted Text
Medicare Advantage Beneficiary Customer Satisfaction Survey Email states: The Centers for Medicare and Medicaid Services (CMS) requests that you complete a satisfaction survey for the resolution of your complaint <complaint ID>. Please click here to access the survey. Survey Questions Please answer the following questions: 1. Were you satisfied with the outcome of your complaint? ☐ Yes ☐ No 2. Are you satisfied with the customer service you received today? ☐ Yes ☐ No 3. Did you first contact the plan for resolution before filing this complaint?? ☐ Yes ☐ No 4. How were you notified of the solution? ☐ Telephone ☐ Written ☐ Telephone and written 5. Is there any additional information you would like to share with us regarding your experience? [Open text box] PRA Disclosure Satement 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 [0938-1382]. This collection is intended to assess beneficiary satisfaction with the resolution of complaints entered in the Health Plan Management System (HPMS) Complaints Tracking Module (CTM) handled by CMS Medicare Customer Service, specifically the Medicare Customer Solutions Group (MCSG). The time required to complete this information collection is estimated to average less than 2 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, to review and complete the information collection. This information collection is voluntary and the data collected will be maintained confidentially in accordance with the Privacy Act of 1974. The information uses are discussed in the System of Records Notice (SORN) number is 09-70-0500. 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.