OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (CMS-10415)

ICR 201605-0938-002 · OMB 0938-1185 · Historical Active

Forms and Documents
Document
Name
Status
Form and Instruction
 New
Form and Instruction
 Unchanged
Form and Instruction
 Unchanged
Form and Instruction
 Unchanged
Form and Instruction
 Unchanged
Form and Instruction
 Unchanged
Form and Instruction
 Unchanged
Form and Instruction
 Unchanged
Form and Instruction
 Unchanged
Supplementary Document
2016-08-05
Supplementary Document
2016-05-02
Justification for No Material/Nonsubstantive Change
2016-05-02
Supporting Statement B
2015-12-29
Supporting Statement A
2016-04-04
IC Document Collections
IC ID
Document
Title
Status
222911 New
219438 Unchanged
219437 Unchanged
219436 Unchanged
219435 Unchanged
219434 Unchanged
219433 Unchanged
219432 Unchanged
219431 Unchanged
ICR Details
0938-1185 201605-0938-002
Historical Active 201512-0938-013
HHS/CMS
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (CMS-10415)
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved with change 08/05/2016
Retrieve Notice of Action (NOA) 05/02/2016
  Inventory as of this Action Requested Previously Approved
04/30/2019 04/30/2019 04/30/2019
1,000,000 0 1,000,000
50,000 0 50,000
0 0 0
This collection of information is necessary to enable the Agency to garner customer and stakeholder feedback in an efficient, timely manner, in accordance with our commitment to improving service delivery. The information collected from our customers and stakeholders will help ensure that users have an effective, efficient, and satisfying experience with the agency's programs. This feedback will provide insights into customer or stakeholder perceptions, experiences and expectations, provide an early warning of issues with service, or focus attention on areas where communication, training or changes in operations might improve delivery of products or services. These collections will allow for ongoing, collaborative and actionable communications between the Agency and its customers and stakeholders. It will also allow feedback to contribute directly to the improvement of program management.
EO: EO 12862 Name/Subject of EO: Setting Customer Service Standards
  
None
Not associated with rulemaking
  80 FR 66904 10/30/2015
80 FR 81550 12/30/2015
No
9
IC Title Form No. Form Name
Medicare Part D Beneficiaries' Satisfaction on Potential Process Changes Associated With Comprehensive Medication Reviews (CMRs) and Targeted Medication Reviews (TMRs) (CMS-10396) CMS-10396 Telephone Interview Script
(CMS-10626) End Stage Renal Disease Quality Reporting System (EQRS) Customer Satisfaction and Task Prioritization Survey for the EQRS Release 1.0 Project. CMS-10626 CrownWeb Facility User Survey
Beneficiary Contact Center Customer Satisfaction Survey CMS-10415 IVR Phone Script for Survey
Reporting for the Health Insurance Marketplace and Qualified Health Plan Enrollee Experience Surveys: Health Insurance Marketplace Consumer Experience Surveys Project (CMS-10534) CMS-10534 Cognitive Interview Guide, Screener and Consent Forms
QualityNet.org and QualityNet Secure Portal Customer Satisfaction and Task Prioritization Survey for Phase 1 of the QualityNet Portal (QNP) redesign project (CMS-10590) CMS-10590 Quality Net User Survey
End Stage Renal Disease (ESRD) Grievant Satisfaction Survey (IC#5) - Round 2 GenIC#5 ESRD Greivant Satisfaction Survey Version 2.0
Evaluation of Stakeholder Training - Health Insurance Marketplace and Market Stabilization Programs CMS-10415 Stakeholder Training Forms
Usability Testing and Evaluation for Phase 1 of the QualityNet Portal (QNP) Redesign Project (CMS-10588) CMS-10588 Usability Test Script
Cognitive Testing for the Marketplace Dental Survey (CMS-10591) CMS-10591 Marketplace Dental Survey Cognitive Testing Eligibility Screener
  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 1,000,000 1,000,000 0 0 0 0
Annual Time Burden (Hours) 50,000 50,000 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
Of the original 25,000 hours that were approved, CMS used 22,261 hours. We are seeking to carryover 6,566 hours and requesting an additional 43,434 hours, for a total of 50,000 hours.
$250,000
Yes Part B of Supporting Statement
No
Yes
No
No
Uncollected
William Parham 4107864669
  No
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.
05/02/2016