ICR Documents

Document Date Uploaded
CMS-P-0015A.Supporting Statement Part A_Final.docx 04/08/2025

Document Date Uploaded
CMS-P-0015A_0938-0568_SSB_clean.docx 04/08/2025

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
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
Nonsubstantive Change Request Memo CMS-P-0015A.Nonsubstantive Change Request Memo.docx Justification for No Material/Nonsubstantive Change 04/08/2025

Author Name Comment Document Author Affiliation Sponsoring Org. Type Category Date of Comment Date Comment Received