ICR Documents

Supporting Statement A Document Date Uploaded CMS-P-0015A 0938-0568_SSA_8.28.23_clean.docx 09/11/2023 Supporting Statement B Document Date Uploaded CMS-P-0015A_0938-0568_SSB_8.28.23_clean.docx 09/11/2023 Supplementary Documents Title Document Document Type Date Uploaded Respondent Newsletter MCBSRespondentNewsletter.pdf Supplementary Document 06/26/2023 MCBS Calendar ENG MCBSCalendar.pdf Supplementary Document 06/26/2023 AtTheDoorEnglish AtDoorSheet.pdf Supplementary Document 06/26/2023 HIPAA Letter HIPAALetter.pdf Supplementary Document 06/26/2023 Resident Consent Form ResConsentForm.pdf Supplementary Document 06/26/2023 Next of Kin Consent Form NextofKinForm.pdf Supplementary Document 06/26/2023 CAPI Screenshots of Introductory Screen and Thank You Screen Attachment 6. CAPI screenshots.pdf Supplementary Document 06/26/2023 Facility Advance Letter_InPerson FacAdvanceLetter.pdf Supplementary Document 06/26/2023 MCBS Facility Broc MCBSFacilityBrochure.pdf Supplementary Document 06/26/2023 Community Advance Letter_Phone_English ComAdvLetterContactYou.pdf Supplementary Document 06/26/2023 Community Authority Letter CommunityAuthLetter.pdf Supplementary Document 06/26/2023 Community Brochure_InPerson_English MCBSCommunityBrochure.pdf Supplementary Document 06/26/2023 Community Brochure_Phone_English RedesignedComBrochure.pdf Supplementary Document 06/26/2023 IAQ Brochure English IncomeandAssetsBrochure.pdf Supplementary Document 06/26/2023 Non-response Letter_Continuing_English NonResponseLetter.pdf Supplementary Document 06/26/2023 Reminder Letter_In Person_English ReminderLetter.pdf Supplementary Document 06/26/2023 Reminder Letter_Phone_English Reminder Letter_Phone_English.docx Supplementary Document 11/23/2020 Reminder Postcard_InPerson ReminderPostcard.pdf Supplementary Document 06/26/2023 Reminder Postcard_Phone Reminder Postcard_Phone.docx Supplementary Document 11/23/2020 Thank You Letter English CMSThankYouLetter.pdf Supplementary Document 06/26/2023 2023 Content Management Cycle Cognitive Testing Report Attachment 7. 2023 Testing Report.pdf Supplementary Document 06/26/2023 Community Advance Letter Multimode ComAdvLetterContactYou.pdf Supplementary Document 03/29/2022 Community Reminder Advance Letter Multimode ComAdvLetterCallUs.pdf Supplementary Document 06/26/2023 Advance Letter FAQ AdvLetterFAQEnclosure.pdf Supplementary Document 03/29/2022 Based FAQ BaseFAQEnclosure.pdf Supplementary Document 06/26/2023 Base Thank you Letter BaseThankYouLetter.pdf Supplementary Document 06/26/2023 Community Language Insert ComLanguageInsert.pdf Supplementary Document 06/26/2023 Facility Advance Letter Billing Offices FacAdvLetterBillOffices.pdf Supplementary Document 06/26/2023 Facility Prepare Interview Letter FacPrepInterviewLetter.pdf Supplementary Document 06/26/2023 Facility Thank You Letter FacThankYouLetter.pdf Supplementary Document 06/26/2023 Health Care Statement Gaining Cooperation Letter HCStatementGPLetter.pdf Supplementary Document 06/26/2023 Redesigned Community Brochure RedesignedComBrochure.pdf Supplementary Document 03/29/2022 60-day Responses to Public Comments Responses to Public Comments_60day.docx Supplementary Document 06/26/2023 Crosswalk 2024 Full Clearance 30-Day Crosswalk.docx Supplementary Document 06/26/2023 MCBS Revision to Current Clearance MCBS 2024 Summary of Item-Level Changes_06052023.pdf Supplementary Document 06/26/2023 2024 Content Management Cycle Cognitive Testing Report Attachment 8. 2024 Testing Report.pdf Supplementary Document 06/26/2023 Fall 2023 Expanded Outreach Efforts Fall 2023 Expanded Outreach Efforts.docx Supplementary Document 09/11/2023 Public Comments Author Name Comment Document Author Affiliation Sponsoring Org. Type Category Date of Comment Date Comment Received LaRoche, Kristen CareQuest.pdf Vice President, Public Affairs CareQuest Email Simple 05/15/2023 05/15/2023 Anonymous University of Minnesota Combined.pdf University of Minnesota Email Multiple 05/23/2023 05/23/2023 Holland, Sarah Virginia Health Catalyst.pdf Chief Executive Officer Virginia Health Catalyst Email Simple 05/19/2023 05/19/2023 Cooley, Ralph A. Dental Quality Alliance.pdf Chair, DQA DQA Email Simple 04/21/2023 04/21/2023