Publication Usage Survey

Forms and Documents

Document Name	Status
Form CMS-10080 Publication Usage Study Form and Instruction	Modified
CMS-10080 (0938-0892) Pub use Supporting_Statement_B FINAL - CLEAN (5-11-10).docx Supporting Statement B	2010-07-08
0938-0892_Supporting_Statement_Appendix_A.doc Supplementary Document	2009-08-28
CMS-10080 (0938-0892) Pub use Supporting_Statement_A FINAL - CLEAN (5-11-10).docx Supporting Statement A	2010-07-08

IC Document Collections

IC ID	Document Title	Status
43671	Publication Usage Study Form and Instruction	Modified

ICR Details

OMB Control No: 0938-0892	ICR Reference No: 200910-0938-002
Status: Historical Active	Previous ICR Reference No: 200606-0938-010
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Publication Usage Survey
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: 07/16/2010
	Date Received in OIRA: 10/02/2009
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2013	36 Months From Approved	07/31/2010
Responses	3,880	0	3,880
Time Burden (Hours)	970	0	1,356
Cost Burden (Dollars)	0	0	0

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Abstract: The Publication Usage survey was developed to gather information from people who request or access Medicare publications, to ensure comprehension, usability, and use of the publications. CMS is seeking understanding about whether publications have been effective in informing members of the Medicare audience regarding policy and benefits. Included in the survey are questions regarding the satisfaction of publication users with specific publications and whether the information they received informed them about the Medicare program. Information gathered in this survey will be used only for purposes of targeting and improving communications with Medicare beneficiaries, caregivers, partners, and community organizations.

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Authorizing Statute(s): None

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:
	74 FR 30574	06/26/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 44368	08/28/2009
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Publication Usage Study	CMS-10080	Publication Usage Survey

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ICR Summary 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	3,880	3,880	0	0	0	0
Annual Time Burden (Hours)	970	1,356	0	-386	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: This submission is a revision of the currently approved collection because the collection instrument has been revised. Several question were deleted, several were added, and others were clarifed. In addition to the content of the survey, the time allotted for completing the survey was reduced from approximately 20 mintes per survey to 15 minutes per survey.

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Annual Cost to Federal Government: $410,000

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

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? 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]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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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: 10/02/2009

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