Generic Clearance for Questionnaire Testing and Methodological Research for the Medicare Current Beneficiary Survey (MCBS) (CMS-10549)

Forms and Documents

Document Name	Status
Form CMS-10549: GenIC#2 GenIC IC #2 - Cognitive Testing for Questions LGBT Form and Instruction	New
Form CMS-10549 MCBS Testing - Limited English Proficiency Form and Instruction	New
CMS-10549_MCBS Generic Clearance_ Supporting Statement B.PDF Supporting Statement B	2015-04-02
CMS-10549_MCBS Generic Clearance_Supporting Statement A.PDF Supporting Statement A	2015-04-02

IC Document Collections

IC ID	Document Title	Status
217196	GenIC IC #2 - Cognitive Testing for Questions LGBT Form and Instruction	New
217079	MCBS Testing - Limited English Proficiency Form and Instruction	New

ICR Details

OMB Control No: 0938-1275	ICR Reference No: 201504-0938-003
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Generic Clearance for Questionnaire Testing and Methodological Research for the Medicare Current Beneficiary Survey (MCBS) (CMS-10549)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/08/2015
	Date Received in OIRA: 04/02/2015
Terms of Clearance: Approved consistent with the understanding that CMS will submit requests individual collections under this generic clearance to OMB. Specifically, CMS is authorized to submit GenIC requests under this ICR in the form of a memo that clearly describes the goals of the work, the specific research questions, methods, and recruiting procedures. CMS will also upload ICs as well as any supplementary material that the participant may see (e.g., recruitment advertisements, consent forms). OMB will strive to provide feedback on the individual collections within ten working days, whenever possible. Standard incentives for respondents for cognitive testing is $40.00 and focus groups is $50-75. Higher incentives must be accompanied by justifications. Field tests will

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2018	36 Months From Approved
Responses	1,500	0	0
Time Burden (Hours)	1,117	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This new OMB generic clearance request is for Medicare Current Beneficiary Survey (MCBS) Questionnaire Testing and Methodological Research. This request encompasses development and testing of MCBS questionnaires, instrumentation, as well as methodological experiments. The MCBS (OMB No. 0938-0568) is an in-person, nationally-representative, longitudinal survey of Medicare beneficiaries.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Research and investigations generally
  

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:
	80 FR 5118	01/30/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 17763	04/02/2015
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
GenIC IC #2 - Cognitive Testing for Questions LGBT	CMS-10549: GenIC#2	GenIC#2 - MCBS Cognitive Testing LGBT Instruments
MCBS Testing - Limited English Proficiency	CMS-10549	Cognitive Testing for Limited English Proficiency

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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	1,500	0	0	1,500	0	0
Annual Time Burden (Hours)	1,117	0	0	1,117	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new information collection request.

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

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]? No

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: 04/02/2015

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