Appendix C3 Telephone Survey Introduction Script (English)

Appendix C3.
Telephone Survey Introduction Script

(English)

I am calling on behalf of the Office of Medicare Hearings and Appeals within the U.S. Department of Health and Human Services. The purpose of my call is to learn more about the level of customer service you received when you experienced the Medicare Administrative Law Judge hearing process.

The Office of Medicare Hearings and Appeals has asked my firm, 2M Research, to administer the survey in order to keep your answers completely anonymous. We will not reveal your name, or other personal identifying information, with your comments to the survey or in any report to the government.

As we go through the survey, when we say “OMHA” I mean the Office of Medicare Hearings and Appeals.

Do you have any questions for me before we begin the survey?

-------------------------------------------------------------------------------------------------------------------

(to be included in internet version and read upon request for telephone version)

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0990-0330. The time required to complete this information collection is estimated to average 11 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Health & Human Services, OS/OCIO/PRA, 200 Independence Ave., S.W., Suite 537-H, Washington D.C. 20201, Attention: PRA Reports Clearance Officer

1