Survey of Newly Eligible Medicare Beneficiaries

Forms and Documents

Document Name	Status
Form CMS-10050 Survey of Newly Eligible Medicare Beneficiaries Form and Instruction	Modified
CMs-10050.Supporting_Statement_B.doc Supporting Statement B	2009-08-17
CMS-10050.Supporting Statement A.doc Supporting Statement A	2009-08-17

IC Document Collections

IC ID	Document Title	Status
43669	Survey of Newly Eligible Medicare Beneficiaries Form and Instruction	Modified

ICR Details

OMB Control No: 0938-0869	ICR Reference No: 200910-0938-017
Status: Historical Inactive	Previous ICR Reference No: 200606-0938-015
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Survey of Newly Eligible Medicare Beneficiaries
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Withdrawn and continue	Conclusion Date: 07/22/2010
	Date Received in OIRA: 10/30/2009
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2009	36 Months From Approved	07/31/2010
Responses	2,400	0	2,400
Time Burden (Hours)	800	0	800
Cost Burden (Dollars)	0	0	0

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Abstract: CMS must have measure(s) over time of what beneficiaries know and understand about the Medicare program now to be able to quantify and attribute any changes to their understanding or behavior to information/education initiatives. Measuring beneficiary information needs and knowledge over time will help us to evaluate the impact of information/education and other initiatives as well as to understand how the population is changing apart from such initiatives.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: US Public Service Act
  

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 27040	06/05/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 41141	08/14/2009
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
Survey of Newly Eligible Medicare Beneficiaries	CMS-10050	Survey of Newly Eligible Medicare Beneficiaries

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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 is a revision of a previously approved collection. The total number of respondents has decreased from 2,400 respondents in the 2006 New Enrollee survey to the current estimate of 1,200 respondents. We have changed the annual burden accordingly. We are submitting a revision to the currently approved collection because we made a program change with respect to the timing of the collection of the data. We reduced the collection schedule from four times per year to once per year.

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Annual Cost to Federal Government: $180,000

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: 10/30/2009

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