Patient-Reported Indicator Survey (PaRIS) (CMS-10792)

Forms and Documents

Document Name	Status
Form CMS-10792 PaRIS Survey Form and Instruction	New
Form CMS-10792 PaRIS Eligibility Screener Form and Instruction	New
CMS-10792_0938-NEW_SSB.docx Supporting Statement B	2022-03-01
PaRIS_PublicComment_Response.docx Supplementary Document	2022-03-01
CMS-10792_0938-NEW_SSA.docx Supporting Statement A	2022-03-01
Attach4_PaRISCogTestReport.pdf Supplementary Document	2022-02-22
Attach3_PaRIS_FAQs.pdf Supplementary Document	2022-02-22
Attach3_PaRIS_ReminderPostcard.pdf Supplementary Document	2022-02-22
Attach3_PaRIS_AdvLtr.pdf Supplementary Document	2022-02-22

IC Document Collections

IC ID	Document Title	Status
251724	PaRIS Survey Form and Instruction	New
251722	PaRIS Eligibility Screener Form and Instruction	New

ICR Details

OMB Control No:	ICR Reference No: 202202-0938-004
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No: OEDA
Title: Patient-Reported Indicator Survey (PaRIS) (CMS-10792)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 03/02/2022

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	12,492	0
Time Burden (Hours)	3,814	0
Cost Burden (Dollars)	0	0

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Abstract: The Centers for Medicare and Medicaid Services (CMS) invites comments on a proposed new Information Collection Request (ICR) to conduct the International Survey of People Living with Chronic Conditions (hereafter referred to as the PaRIS Survey). This survey has been developed by a collaborative workgroup under the auspices of the Organization for Economic Cooperation and Development (OECD), an international organization that works with governments, policy makers, and citizens to shape policies that foster prosperity, equality, opportunity, and well-being for all. The OECD launched the PaRIS initiative in 2017 to address gaps in health outcomes measures, particularly regarding user experiences with health care services. OECD member countries, including the U.S., are working together to develop, standardize, and implement indicators that measure outcomes and experiences of health care that matter most to people. The PaRIS Survey will provide a common set of measures that support policy makers across participating countries to improve health care delivery. On behalf of the Department of Health and Human Services (DHHS) Assistant Secretary for Planning and Evaluation (ASPE), the Office of Enterprise Data and Analytics (OEDA) in CMS has been designated as the lead participant for the U.S. The PaRIS Survey will help to close critical policy gaps by focusing on: (1) Patient Reported Experience Measures (PREMS) which measure how patients experience health care, and (2) Patient Reported Outcome Measures (PROMS) which measure how patients assess the results of the care they receive. The PaRIS survey includes both PREMS and PROMS items and aims to collect vital information about primary health care, by asking about topics such as the respondent’s health, health behaviors, patient activation and confidence in managing their health care, experiences with health care and health providers including access to health care, quality of life, physical functioning, and psychological well-being.

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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:
	86 FR 62173	11/09/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 9625	02/22/2022
Did the Agency receive public comments on this ICR? Yes

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

IC Title	Form No.	Form Name
PaRIS Eligibility Screener	CMS-10792	PaRIS Eligibility Screener
PaRIS Survey	CMS-10792	OECD PaRIS Patient Questionnaire

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ICR Summary of Burden

	Total Request	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	12,492	0	0	12,492	0	0
Annual Time Burden (Hours)	3,814	0	0	3,814	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 collection estimates that 7,348 Medicare beneficiaries will be administered a 3-minute (0.05 hr.) screener. From this group, CMS expects 5,144 to have seen a medical provider in the last six months and therefore, to be administered the 40-minute (0.67 hr.) PaRIS survey. Total Annual Hourly burden is calculated at 3,814 hours for this PaRIS Survey,

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Annual Cost to Federal Government: $1,432,251

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

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

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? No

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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: 03/02/2022

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