ICR Documents

Supporting Statement A Document Date Uploaded CMS-A-0015A (0938-0568) Supporting Statement A - 6-13-16 (clean).docx 06/22/2016 Supporting Statement B Document Date Uploaded CMS-P-0015A (0938-0568) Supporting Statement B - 6-22-16 (clean).docx 06/22/2016 Supplementary Documents Title Document Document Type Date Uploaded Attachment 2 2015-2016 MCBS Calendar_English Attachment 2 2015-2016 MCBS Calendar_English.pdf Supplementary Document 05/06/2016 Attachment 2 At the Door Sheet_English Attachment 2 At the Door Sheet_English.pdf Supplementary Document 05/06/2016 Attachment 2 CMS Advance Letter_Community_English Attachment 2 CMS Advance Letter_Community_English.pdf Supplementary Document 05/06/2016 Attachment 2 CMS Thank You Letter_Community_English Attachment 2 CMS Thank You Letter_Community_English.docx Supplementary Document 05/06/2016 Attachment 2 Community Authority Letter Attachment 2 Community Authority Letter.pdf Supplementary Document 05/06/2016 Attachment 2 IAQ Brochure_English Attachment 2 IAQ Brochure_English.pdf Supplementary Document 05/06/2016 Attachment 2 MCBS Brochure_Community_Eng Attachment 2 MCBS Brochure_Community_Eng.pdf Supplementary Document 05/06/2016 Attachment 2 MCBS Respondent Newsletter 2016_Draft Attachment 2 MCBS Respondent Newsletter 2016_Draft.pdf Supplementary Document 05/06/2016 Attachment 3 MCBS Community Questionnaire Flow Diagrams_R76 Attachment 3 MCBS Community Questionnaire Flow Diagrams_R76.pdf Supplementary Document 05/06/2016 MCBS Cognitive Testing LGBT Items 10 day letter MCBS Cognitive Testing LGBT Items 10 day letter_revised072815clean.docx Supplementary Document 05/06/2016 Attachment 7 CMS Advance Letter_Facility_English Attachment 7 CMS Advance Letter_Facility_English.pdf Supplementary Document 05/06/2016 Attachment 7 HIPAA Letter_English Attachment 7 HIPAA Letter_English.pdf Supplementary Document 05/06/2016 Attachment 7 MCBS Brochure_Facility_Eng Attachment 7 MCBS Brochure_Facility_Eng.pdf Supplementary Document 05/06/2016 Attachment 7 Next of Kin Consent Form Attachment 7 Next of Kin Consent Form.pdf Supplementary Document 05/06/2016 Attachment 7 Resident Consent Form Attachment 7 Resident Consent Form.pdf Supplementary Document 05/06/2016 2016 Winter Respondent Newsletter (6-15-16) 2016 Winter Respondent Newsletter (6-15-16).pdf Supplementary Document 06/22/2016 2016-17 MCBS Calendar-Planner (6-15-16) 2016-17 MCBS Calendar-Planner (6-15-16).pdf Supplementary Document 06/22/2016 At the Door Sheet_English (6-15-16) At the Door Sheet_English (6-15-16).pdf Supplementary Document 06/22/2016 Community Advance Letter_English (6-15-16) Community Advance Letter_English (6-15-16).pdf Supplementary Document 06/22/2016 Community Authority Letter (6-15-16) Community Authority Letter (6-15-16).pdf Supplementary Document 06/22/2016 IAQ Brochure (6-15-16) IAQ Brochure (6-15-16).pdf Supplementary Document 06/22/2016 MCBS Community Brochure (6-15-16) MCBS Community Brochure (6-15-16).pdf Supplementary Document 06/22/2016 Thank You Letter (6-15-16) Thank You Letter (6-15-16).pdf Supplementary Document 06/22/2016 Facility Advance Letter (6-15-16) Facility Advance Letter (6-15-16).pdf Supplementary Document 06/22/2016 HIPAA Letter_English. (6-15-16) HIPAA Letter_English. (6-15-16).pdf Supplementary Document 06/22/2016 MCBS Faclity Brochure. (6-15-16) MCBS Faclity Brochure. (6-15-16).pdf Supplementary Document 06/22/2016 Next of Kin Consent Form (6-15-16) Next of Kin Consent Form (6-15-16).pdf Supplementary Document 06/22/2016 Resident Consent Form (6-15-16) Resident Consent Form (6-15-16).pdf Supplementary Document 06/22/2016 Attachment A R79 HFQ revisions (Feb 2017 non-sub change request) Attachment A R79 HFQ revisions (Feb 2017 non-sub change request).pdf Supplementary Document 02/27/2017 Attachment B R79 MPQ revisions (Feb 2017 non-sub change request) Attachment B R79 MPQ revisions (Feb 2017 non-sub change request).pdf Supplementary Document 02/27/2017 Attachment C R79 SCQ revisions (Feb 2017 non-sub change request) Attachment C R79 SCQ revisions (Feb 2017 non-sub change request).pdf Supplementary Document 02/27/2017 Attachment D R79 PMQ revisions (Feb 2017 non-sub change request) Attachment D R79 PMQ revisions (Feb 2017 non-sub change request).pdf Supplementary Document 02/27/2017 Attachment E R79 PAQ revisions (Feb 2017 non-sub change request) Attachment E R79 PAQ revisions (Feb 2017 non-sub change request).pdf Supplementary Document 02/27/2017 Attachment F R80 USQ revisions (Feb 2017 non-sub change request) Attachment F R80 USQ revisions (Feb 2017 non-sub change request).pdf Supplementary Document 02/27/2017 Attachment G R80 ACQ revisions (Feb 2017 non-sub change request) Attachment G R80 ACQ revisions (Feb 2017 non-sub change request).pdf Supplementary Document 02/27/2017 Attachment A - R82 PVQ - (10-27-17 non sub change request) Attachment A - R82 PVQ - (10-27-17).PDF Supplementary Document 11/03/2017 Attachment B - R82 NAQ - (10-27-17 non-sub change request) Attachment B - R82 NAQ - (10-27-17).PDF Supplementary Document 11/03/2017 Attachment C - R82 HFQ - (10-27-17 non-sub change request) Attachment C - R82 HFQ - (10-27-17).PDF Supplementary Document 11/03/2017 0938-0568 (CMS-P-0015A) Attachment A - R82 NAQ (1-29-18) 0938-0568 (CMS-P-0015A) Attachment A - R82 NAQ (1-29-18).PDF Supplementary Document 02/22/2018 0938-0568 (CMS-P-0015A) Attachment B - R82 HFQ (1-29-18) 0938-0568 (CMS-P-0015A) Attachment B - R82 HFQ (1-29-18).PDF Supplementary Document 02/22/2018 0938-0568. Justification of Non-sub change 0938-0568.MCBS Justification of Nonsubstantive change request R79 R80 (Feb 2017 non-sub change request).docx Justification for No Material/Nonsubstantive Change 02/27/2017 0938-0568.Justification of Non-substantive Change (10-27-17) CMS-P-0015A (0938-0568) MCBS Nonsubstantive change request R82 (10-27-17).docx Justification for No Material/Nonsubstantive Change 11/03/2017 0938-0568 (CMS-P-0015A) MCBS Nonsubstantive change request R82 revised (1-29-18) 0938-0568 (CMS-P-0015A)MCBS Nonsubstantive change request R82 revised (1-29-18).docx Justification for No Material/Nonsubstantive Change 02/22/2018 Public Comments Author Name Comment Document Author Affiliation Sponsoring Org. Type Category Date of Comment Date Comment Received