Health Care Financing Administration 7500 Security Blvd., Baltimore, MD 21244-1850

R -- REDESIGN OF THE MEDICARE PREMIUM PAYMENT DUE FORM POC Debbie Strittmatter, Contract Specialist, (410)786-5136. The Health Care Financing Administration (HCFA) is seeking to identify sources for the redesign of the ''Notice of Medicare Premium Payment Due Form'' (HCFA-500). HCFA is required by law to collect Medicare premiums from Medicare beneficiaries who do not have premiums paid by a State agency or do not have premiums deducted from either a Social Security, Railroad Retirement Board or Civil Service annuity check. The HCFA-500 Notice assists HCFA in accomplishing this task. The current Notice has been in existence for more than 15 years and has not been updated to meet the needs of the Medicare beneficiary nor the changing needs of HCFA. The contractor will develop a notice which meets HCFA's current data collection needs and which is concise and easily understood by the Medicare beneficiary. To achieve this objective the contractor will be required to meet with HCFA components, senior citizen advocacy groups throughout the United States, and other groups during various stages of the project in order to obtain first hand knowledge of billing notice concerns and needs. Finally the contractor will be required to test the redesigned notice through focus groups to ensure that it is clear, concise and understandable. The new billing notice shall be designed using the most advanced concepts in technology, engineering, forms design and printing. The form will be required in both English and Spanish (Spanish dialect). The project shall be completed within a 12 month period. Interested parties should submit a written capability statement no later than March 14, 1996. This statement must be substantiated by complete and detailed technical literature and references. Firms must specify a name and telephone number of a point of contact and indicate their size status under SIC 8741. The purpose of this Sources Sought synopsis is to identify potential responsible sources only and does not constitute an RFP. Respondents will be included on the mailing list for any RFP that may result from this synopsis. The Government does not intend to award a contract on the basis of this notice or otherwise pay for any information solicited. Documentation should be submitted to HCFA, OAG, Attn.: Debbie Strittmatter, C2-21-15, 7500 Security Blvd., Baltimore, MD 21244. (0060)

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