ICR Documents

Supporting Statement A Document Date Uploaded CMS-P-0015A 0938-0568_SSA_clean.docx 08/24/2022 Supporting Statement B Document Date Uploaded CMS-P-0015A_0938-0568_SSB_clean.docx 08/24/2022 Supplementary Documents Title Document Document Type Date Uploaded Respondent Newsletter RespondentNewsletter.pdf Supplementary Document 03/29/2022 MCBS Calendar ENG MCBSCalendar.PDF Supplementary Document 03/29/2022 AtTheDoorEnglish AtDoorSheet.pdf Supplementary Document 03/29/2022 Refusal Letter Refusal Letter_Com_Continuing Rs_Eng_FM800.doc Supplementary Document 04/16/2019 HIPAA Letter HIPAALetter.pdf Supplementary Document 03/29/2022 Resident Consent Form ResConsentForm.pdf Supplementary Document 03/29/2022 Next of Kin Consent Form NextofKinForm.pdf Supplementary Document 03/29/2022 CAPI Screenshots of Introductory Screen and Thank You Screen Attachment 6. CAPI screenshots.docx Supplementary Document 03/29/2022 Facility Advance Letter_InPerson FacAdvanceLetter.pdf Supplementary Document 03/29/2022 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 ComAdvLetterContactYou.pdf Supplementary Document 03/29/2022 Community Authority Letter CommunityAuthLetter.pdf Supplementary Document 03/29/2022 Community Authority Letter_NGACO Community Authority Letter_NGACO.docx Supplementary Document 11/23/2020 Community Brochure_InPerson_English MCBSCommunityBrochure.pdf Supplementary Document 03/29/2022 Community Brochure_Phone_English Community Brochure_Phone_English.pdf Supplementary Document 11/23/2020 IAQ Brochure English IncomeandAssetsBrochure.pdf Supplementary Document 03/29/2022 Non-response Letter_Continuing_English NonResponseLetter.pdf Supplementary Document 03/29/2022 Reminder Letter_In Person_English ReminderLetter.pdf Supplementary Document 03/29/2022 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 ReminderPostcard.pdf Supplementary Document 03/29/2022 Reminder Postcard_Phone Reminder Postcard_Phone.docx Supplementary Document 11/23/2020 Thank You Letter English CMSThankYouLetter.pdf Supplementary Document 03/29/2022 2023 Content Management Cycle Cognitive Testing Report Attachment 7. 2023 Testing Report.pdf Supplementary Document 05/09/2022 Community Advance Letter Multimode ComAdvLetterContactYou.pdf Supplementary Document 03/29/2022 Community Reminder Advance Letter Multimode ComAdvLetterCallUs.pdf Supplementary Document 03/29/2022 LGBT Final Summary Report Att8.LGBTSumryReportFinal.pdf Supplementary Document 03/29/2022 Advance Letter FAQ AdvLetterFAQEnclosure.pdf Supplementary Document 03/29/2022 Based FAQ BaseFAQEnclosure.pdf Supplementary Document 03/29/2022 Base Thank you Letter BaseThankYouLetter.pdf Supplementary Document 03/29/2022 Community Language Insert ComLanguageInsert.pdf Supplementary Document 03/29/2022 Facility Advance Letter Billing Offices FacAdvLetterBillOffices.pdf Supplementary Document 03/29/2022 Facility Prepare Interview Letter FacPrepInterviewLetter.pdf Supplementary Document 03/29/2022 Facility Thank You Letter FacThankYouLetter.pdf Supplementary Document 03/29/2022 Health Care Statement Gaining Cooperation Letter HCStatementGPLetter.pdf Supplementary Document 03/29/2022 Redesigned Community Brochure RedesignedComBrochure.pdf Supplementary Document 03/29/2022 60-day Responses to Public Comments Responses to Public Comments.docx Supplementary Document 05/16/2022 Crosswalk 2023 Full Clearance 30-Day Crosswalk.docx Supplementary Document 04/04/2022 30-day Response to Public Comments Responses to Public Comments.docx Supplementary Document 05/16/2022 Crosswalk (after 30-day comment period) 2023 Full Clearance 30-Day Crosswalk.docx Supplementary Document 05/16/2022 Public Comments Author Name Comment Document Author Affiliation Sponsoring Org. Type Category Date of Comment Date Comment Received Vasquez, Luis PC_202203-0938-013_050422_042125_1.pdf Williams Institute_CMS MCBS_5.4.22.pdf The Williams Institute Other -- Reginfo.gov Simple 05/04/2022 05/04/2022 Goldberg, Naomi Movement Advancement Project.pdf Deputy Director Movement Advancement Project (MAP) Email Simple 03/22/2022 03/22/2022 Anonymous CMS-2022-0023-DRAFT-0001.pdf audacity2speak Email Simple 03/22/2022 03/22/2022 Hall, Elizabeth P. Anthem Comments_Medicare Current Beneficiary Survey(2022-03-22).pdf Anthem, Inc. Email Simple 03/22/2022 03/22/2022 Goldberg, Naomi 2022.05.04 CMS_MedicareCurrentBeneficiarySurvey.pdf Movement Advancement Project Other -- Reginfo.gov Simple 05/04/2022 05/04/2022