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Agenda
Reg Review
ICR
ICR Documents
Supporting Statement A
Document
Date Uploaded
CMS-P-0015A 0938-0568_SSA-EOP Passback2_clean.docx
02/02/2021
Supporting Statement B
Document
Date Uploaded
CMS-P-0015A_0935-0568_SSB_clean.docx
02/02/2021
Supplementary Documents
Title
Document
Document Type
Date Uploaded
Respondent Newsletter
MCBS Newsletter English.pdf
Supplementary Document
11/23/2020
MCBS Calendar ENG
MCBS Calendar English.pdf
Supplementary Document
11/23/2020
AtTheDoorEnglish
At the Door Sheet English.pdf
Supplementary Document
11/23/2020
Refusal Letter
Refusal Letter_Com_Continuing Rs_Eng_FM800.doc
Supplementary Document
04/16/2019
HIPAA Letter
HIPAA Letter.docx
Supplementary Document
11/23/2020
Resident Consent Form
Resident Consent Form.pdf
Supplementary Document
11/23/2020
Next of Kin Consent Form
Next of Kin Consent Form.pdf
Supplementary Document
11/23/2020
CAPI Screenshots of Introductory Screen and Thank You Screen
Attachment7CAPIscreenshots.pdf
Supplementary Document
08/19/2020
Facility Advance Letter_InPerson
Facility Advance Letter_InPerson.docx
Supplementary Document
11/23/2020
Facility Advance Letter_Phone
Facility Advance Letter_Phone.docx
Supplementary Document
11/23/2020
Community Advance Letter_COVID-19
Community Advance Letter_COVID-19.docx
Supplementary Document
11/23/2020
Community Advance Letter_InPerson_English
Community Advance Letter_InPerson_English.pdf
Supplementary Document
11/23/2020
Community Advance Letter_NGACO
Community Advance Letter_NGACO.docx
Supplementary Document
11/23/2020
Community Advance Letter_Phone_English
Community Advance Letter_Phone_English.docx
Supplementary Document
11/23/2020
Community Authority Letter
Community Authority Letter.docx
Supplementary Document
11/23/2020
Community Authority Letter_NGACO
Community Authority Letter_NGACO.docx
Supplementary Document
11/23/2020
Community Brochure_InPerson_English
Community Brochure_InPerson_English.pdf
Supplementary Document
11/23/2020
Community Brochure_Phone_English
Community Brochure_Phone_English.pdf
Supplementary Document
11/23/2020
IAQ Brochure English
IAQ Brochure English.pdf
Supplementary Document
11/23/2020
Non-response Letter_Continuing_English
Non-response Letter_Continuing_English.docx
Supplementary Document
11/23/2020
Reminder Advance Letter_Phone_English
Reminder Advance Letter_Phone_English.docx
Supplementary Document
11/23/2020
Reminder Letter_In Person_English
Reminder Letter_In Person_English.docx
Supplementary Document
11/23/2020
Reminder Letter_NGACO
Reminder Letter_NGACO.docx
Supplementary Document
11/23/2020
Reminder Letter_Phone_English
Reminder Letter_Phone_English.docx
Supplementary Document
11/23/2020
Reminder Postcard_InPerson
Reminder Postcard_InPerson.docx
Supplementary Document
11/23/2020
Reminder Postcard_Phone
Reminder Postcard_Phone.docx
Supplementary Document
11/23/2020
Thank You Letter English
Thank You Letter English.docx
Supplementary Document
11/23/2020
COVID-19 Summer 2020 Supplement Test Report
Attachment 8. COVID-19 Summer 2020 Supplement Test Report.docx
Supplementary Document
02/02/2021
Crosswalk of Changes in Fall COVID-19 Supplement
Attachment 9. Crosswalk of Changes in Fall COVID-19 Supplement.docx
Supplementary Document
02/02/2021
Crosswalk (New Items)
Summary of New Items_Crosswalk.pdf
Supplementary Document
02/02/2021
Public Comments
Author Name
Comment Document
Author Affiliation
Sponsoring Org.
Type
Category
Date of Comment
Date Comment Received
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.