Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Medicare Current Beneficiary Survey (MCBS): Rounds 48-56 (CMS Number CMS-P-0015A) New 3300 3355 0 Form and Instruction CMS-P-0015A Background Questionnaire
Form and Instruction CMS-P-0015A MCBS Facility Round 46 Expenditure Questionnaire
Form and Instruction CMS-P-0015A MCBS Facility Round 46 Health Ins Questionnaire
Form and Instruction CMS-P-0015A MCBS Facility Round 46 Health Status Base Line
Form and Instruction CMS-P-0015A MCBS Facility Round 46 Resident History
Form and Instruction CMS-P-0015A MCBS Facility Round 46 Prescription Medicines
Form and Instruction CMS-P-0015A MCBS Facility Round 46 Use of Services Module
Form and Instruction CMS-P-0015A Facility Screening Interview Script
Form and Instruction CMS-P-0015A MCBS Household Round 46 Questionnaire English
Form and Instruction CMS-P-0015A MCBS Household Round 46 Questionnaire Spanish
Form and Instruction CMS-P-0015A MCBS Household Round 46 Show Cards
Medicare Current Beneficiary Survey (MCBS): Rounds 48-56 (CMS Number CMS-P-0015A) Modified 46200 46970 0 Form and Instruction CMS-P-0015A Background Questionnaire
Form and Instruction CMS-P-0015A MCBS Facility Round 46 Expenditure Questionnaire
Form and Instruction CMS-P-0015A MCBS Facility Round 46 Health Ins Questionnaire
Form and Instruction CMS-P-0015A MCBS Facility Round 46 Health Status Base Line
Form and Instruction CMS-P-0015A MCBS Facility Round 46 Resident History
Form and Instruction CMS-P-0015A MCBS Facility Round 46 Prescription Medicines
Form and Instruction CMS-P-0015A MCBS Facility Round 46 Use of Services Module
Form and Instruction CMS-P-0015A Facility Screening Interview Script
Form and Instruction CMS-P-0015A MCBS Household Round 46 Questionnaire English
Form and Instruction CMS-P-0015A MCBS Household Round 46 Questionnaire Spanish
Form and Instruction CMS-P-0015A MCBS Household Round 46 Show Cards
Total burden requested under this ICR: 49500 50325 0  
To view an IC, click on IC Title