Pursuant to 5 CFR 1320, on the condition that all required data collection instruments associated with the information collection request display OMB control number and current expiration date, the information collection is approved for three (3) years.
Inventory as of this Action
Requested
Previously Approved
09/30/2019
36 Months From Approved
09/30/2016
16,010
0
68,000
4,003
0
17,000
20,013
0
85,000
The data collection methodology used for the Beneficiary Satisfaction will be conducted primarily via mail. A mail-based methodology will achieve the goals of being efficient, effective, and minimally burdensome for beneficiary respondents. A mail-based methodology could yield a response rate of approximately 60 percent. In order to achieve this response rate, we recommend a 3 staged approach to data collection:
1) Mailout of a covering letter, the paper survey questionnaire, and a postage-paid return envelope.
2) Mailout of a post card that thanks respondents and reminds the non-respondents to please return their survey.
3) Mailout of a follow-up covering letter, the paper survey questionnaire, and a postage-paid return envelope.
Using the 3-step mail approach described above, we anticipate that data collection would occur over an 8 to 10 weeks. This is to say, if the first survey mailing were dropped on January 1, we would anticipate completing data collection at the end of February or early March. Data would then be cleaned, scores would be generated, and data would be delivered to CMS. As previously described, we anticipate that a mail-based methodology could yield a response rate of approximately 60 percent. In order to achieve this response rate, we would recommend a 3 staged approach to data collection:
1) Mailout of a covering letter, the paper survey questionnaire, and a postage-paid return envelope.
2) Mailout of a post card that thanks respondents and reminds the non-respondents to please return their survey.
3) Mailout of a follow-up covering letter, the paper survey questionnaire, and a postage-paid return envelope.
Through the pilot test, we will determine the response rate that can be achieved using this approach. If it is deemed necessary, additional mailout reminders can be added to the protocol, or a telephone non-response step can be added to the protocol. Using the 3-step mail approach described above, we anticipate that data collection would occur over an 8 to 10 weeks.
US Code:
42 USC 1320c
Name of Law: Functions of Peer Review Organizations
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:
(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;
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.
Form CMS-10393 Medicare Beneficiary and Family-Centered Satisfaction Survey
CMS-10393 Revised PRA Supporting Stmt-Pt B Passback Clean Final 07 14 2016.docx
Medicare Beneficiary and Family-Centered Satisfaction Survey