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Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
0938-1239
ICR Reference No:
201404-0938-010
Status:
Historical Active
Previous ICR Reference No:
201311-0938-001
Agency/Subagency:
HHS/CMS
Agency Tracking No:
20823
Title:
Nationwide Consumer Assessment of Healthcare Providers and Systems (DCAHPS) Survey for Adults in Medicaid (CMS-10493)
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 with change
Conclusion Date:
05/08/2014
Retrieve Notice of Action (NOA)
Date Received in OIRA:
04/28/2014
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
05/31/2017
36 Months From Approved
Responses
510,051
0
0
Time Burden (Hours)
172,244
0
0
Cost Burden (Dollars)
0
0
0
Abstract:
In 2014, the CMS Centers for Medicare and Medicaid Services (CMCS) plans to conduct a nationwide survey of adults covered by Medicaid using the Consumer Assessment Healthcare Providers and Systems (CAHPS) survey. The survey is to understand Medicaid enrollees' experiences with care, satisfaction with care, and access to care. Collection is critical to the mission of CMS and will sample beneficiaries from four population groups consisting of disabled individuals, non-disabled individuals enrolled in managed care; non-disabled individuals with FFS provider; and individuals dully eligible for Medicare and Medicaid.
Authorizing Statute(s):
PL:
Pub.L. 111 - 148 2701
Name of Law: Patient Protection and Affordable Care Act
Citations for New Statutory Requirements:
PL: Pub.L. 111 - 148 2701 Name of Law: Patient Protection and Affordable Care Act
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
78 FR 43887
07/22/2013
30-day Notice:
Federal Register Citation:
Citation Date:
79 FR 61846
10/04/2013
Did the Agency receive public comments on this ICR?
Yes
Number of Information Collection (IC) in this ICR:
2
IC Title
Form No.
Form Name
Nationwide Consumer Assessment of Healthcare Providers and Systems (DCAHPS) Survey for Adults in Medicaid
CMS-10493, CMS-10493
Phone Script - CAHPS 5.0H Adult Questionnaire (Medicaid)
,
CAHPS 5.0H Adult Questionnaire (Medicaid)
State Burden
CMS-10493, CMS-10493
Phone Script - CAHPS 5.0H Adult Questionnaire (Medicaid)
,
CAHPS 5.0H Adult Questionnaire (Medicaid)
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
510,051
0
510,051
0
0
0
Annual Time Burden (Hours)
172,244
0
172,244
0
0
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
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:
No
Burden Reduction Due to:
Short Statement:
This is a new information collection request.
Annual Cost to Federal Government:
$3,850,000
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]?
Yes
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
Agency Contact:
Mitch Bryman 410 786-5258 Mitch.Bryman@cms.hhs.gov
Common Form ICR:
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:
(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:
04/28/2014
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