Document
PACE Organization Survey
ICR 202610-0938-001 · OMB 0938-1185 · Object 173850900.
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Document Metadata
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
|---|---|
| File Title | PACE Organization Survey |
| Author | Giles, Robyn (CMS/OPOLE) |
| Last Modified By | Writer |
| File Modified | 2023-12-01 |
| File Created | 2026-10-15 |
| Conversion State | complete |
Extracted Text
Question Title
1. My Account Manager is readily accessible
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
Comments
2. Quarterly call conversations with my Account Manager are collaborative and educational.
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
Comments
3. My Account Manager effectively facilitates the resolution of questions/issues and/or directs me to the appropriate resource to obtain an answer.
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
Comments
4. Did you have an audit in the last year? Yes, proceed to question 5. No, proceed to question 6.
Yes
No
5. My Account Manager provides technical support during the corrective action plan monitoring phase, following an audit.
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
Comments
6. How would you rate your experience with your Account Manager.
Exceeded expectations
Met expectations
Below expectations
Comments
7. Do you have any suggestions on how PACE Account Management could be improved?
Yes
No
Comments
PRA Disclosure Statement The purpose of the PRA package is to conduct a survey of PACE (Program of All-inclusive Care of the Elderly) Organizations and obtain information about their satisfaction with their CMS account manager. The results will be used to improve the customer experience. Completion of the survey is voluntary. Under the Privacy Act of 1974 any personally identifying information obtained will be kept private to the extent of the law.
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 0938-1185 (CMS-10748). The time required to complete this information collection is estimated to average 10 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.