ICR Documents

Supporting Statement A Document Date Uploaded CMS-P-0015A 0938-0568_SSA.docx 07/24/2024 Supporting Statement B Document Date Uploaded CMS-P-0015A_0938-0568_SSB.docx 07/11/2024 Supplementary Documents Title Document Document Type Date Uploaded Respondent Newsletter MCBSRespondentNewsletter.pdf Supplementary Document 06/26/2023 MCBS Calendar ENG MCBSCalendar.pdf Supplementary Document 07/11/2024 AtTheDoorEnglish AtDoorSheet.pdf Supplementary Document 07/11/2024 HIPAA Letter HIPAALetter.pdf Supplementary Document 07/11/2024 Resident Consent Form ResConsentForm.pdf Supplementary Document 07/11/2024 Next of Kin Consent Form NextofKinForm.pdf Supplementary Document 07/11/2024 CAPI Screenshots of Introductory Screen and Thank You Screen Attachment 6. CAPI screenshots.pdf Supplementary Document 07/11/2024 Facility Advance Letter_InPerson FacAdvanceLetter.pdf Supplementary Document 07/11/2024 MCBS Facility Broc MCBS Facility Brochure.pdf Supplementary Document 07/11/2024 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 07/11/2024 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 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 Crosswalk (Supporting Statement) 2025 Full Clearance 30-Day Crosswalk of Statements.docx Supplementary Document 07/11/2024 Response to Comments (60-day) Responses to Public Comments.docx Supplementary Document 07/11/2024 Non Response Letter Fraud NonResponseLetterFraud.pdf Supplementary Document 07/11/2024 Public Comments Author Name Comment Document Author Affiliation Sponsoring Org. Type Category Date of Comment Date Comment Received Sloan, Kirsten ACS CAN.pdf Managing Director, Public Policy American Cancer Society Cancer Action Network Email Simple 06/24/2024 06/24/2024 Anonymous undersigned organizations.pdf Undersigned organizations Email Simple 06/25/2024 06/25/2024