Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A) Modified 35998 54426 0 Form CMS-P-0015A Cost Payment Summary
Form CMS-P-0015A Demographic Income
Form CMS-P-0015A End Questionaire
Form CMS-P-0015A Enumeration Summary
Form CMS-P-0015A Home Health Summary
Form CMS-P-0015A interviewer Remarks
Form CMS-P-0015A Mobility of Beneficiaries
Form CMS-P-0015A Post Statement Cost
Form CMS-P-0015A Access to Care
Form CMS-P-0015A Chronic Pain
Form CMS-P-0015A Dental, Vision, and Hearing Care Utilization
Form CMS-P-0015A Drug Coverage
Form CMS-P-0015A Emergency Utilization
Form CMS-P-0015A Health Insurance
Form CMS-P-0015A Home Health
Form CMS-P-0015A Housing_Characteristics
Form CMS-P-0015A Income_and_ Assets
Form CMS-P-0015A Inpatient Utilization
Form CMS-P-0015A Institutional Utilization
Form CMS-P-0015A Introduction
Form CMS-P-0015A Medical Provider Utilzation
Form CMS-P-0015A Nicotine Alcohol
Form CMS-P-0015A No Statement Cost
Form CMS-P-0015A Other Medical Expense
Form CMS-P-0015A Outpatient Utilization
Form CMS-P-0015A Prescribed Medicine Utilization
Form CMS-P-0015A Satisfaction Care
Form CMS-P-0015A Statement Cost Series
Form CMS-P-0015A Beneficiary Knowledge
Form CMS-P-0015A Preventive Care
Form CMS-P-0015A Usual Source of Care
Form CMS-P-0015A Showcards and Reference Cards
Form CMS-P-0015A Facility Showcards
Form CMS-P-0015A Facility Screener
Form CMS-P-0015A Residence History Missing Data
Form CMS-P-0015A Residence History
Form CMS-P-0015A Use of Health Services
Form CMS-P-0015A Background_Questionnaire
Form CMS-P-0015A Background_Questionnaire MIssing Data
Form CMS-P-0015A Expenditures
Form CMS-P-0015A Questionaire Missing Data
Form CMS-P-0015A Questionaire
Form CMS-P-0015A Health_Insurance
Form CMS-P-0015A Health_Status
Form CMS-P-0015A Health Status
Form CMS-P-0015A Cognitive Measures
Form CMS-P-0015A Health_Status_and_Functioning
Form CMS-P-0015A Physical_Measures
Form CMS-P-0015A interviewer Remarks
Form P-0015A COVID-19 Questionnaire Specifications
Form P-0015A MCBS COVID-19 Winter 2021 Facility Supplement
Total burden requested under this ICR: 35998 54426 0  
To view an IC, click on IC Title