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_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 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 Community Advance Letter Multimode R91AdvLetterMulti508C.pdf Supplementary Document 05/04/2021 Community Reminder Advance Letter Multimode R91RemAdvLetterMulti508C.pdf Supplementary Document 05/04/2021 Non-Substantive Justification Document MCBS nonsubstantive change request Adv Mailings.docx Justification for No Material/Nonsubstantive Change 05/04/2021 Public Comments Author Name Comment Document Author Affiliation Sponsoring Org. Type Category Date of Comment Date Comment Received