ICR Documents

Supporting Statement A Document Date Uploaded CMS-P-0015A 0938-0568_SSA.docx 11/21/2025 Supporting Statement B Document Date Uploaded CMS-P-0015A_0938-0568_SSB.docx 11/19/2025 Supplementary Documents Title Document Document Type Date Uploaded Respondent Newsletter MCBSRespondentNewsletter.pdf Supplementary Document 11/18/2025 MCBS Calendar MCBSCalendar.pdf Supplementary Document 11/18/2025 HIPAA Letter HIPAALetter.pdf Supplementary Document 11/18/2025 Resident Consent Form ResConsentForm.pdf Supplementary Document 11/19/2025 Next of Kin Consent Form NextofKinForm.pdf Supplementary Document 11/19/2025 CAPI Screenshots of Introductory Screen and Thank You Screen Attachment 6. CAPI screenshots.pdf Supplementary Document 11/19/2025 Facility Advance Letter_InPerson FacAdvanceLetter.pdf Supplementary Document 11/19/2025 MCBS Facility Broc MCBS Facility Brochure.pdf Supplementary Document 11/19/2025 Community Advance Letter_Phone_English ComAdvLetterContactYou.pdf Supplementary Document 11/19/2025 Community Authority Letter ComAuthLetter.pdf Supplementary Document 11/19/2025 Community Brochure_InPerson_English MCBSCommunityBrochure.pdf Supplementary Document 11/19/2025 Community Brochure_English RedesignedComBrochure.pdf Supplementary Document 11/19/2025 IAQ Brochure English IncomeandAssetsBrochure.pdf Supplementary Document 11/19/2025 Non-response Letter_Continuing_English NonResponseLetter.pdf Supplementary Document 11/19/2025 Reminder Letter_In Person_English ReminderLetter.pdf Supplementary Document 11/19/2025 Reminder Postcard_InPerson ReminderPostcard.pdf Supplementary Document 11/19/2025 Thank You Letter English CMSThankYouLetter.pdf Supplementary Document 11/19/2025 Community Reminder Advance Letter Multimode ComAdvLetterCallUs.pdf Supplementary Document 11/19/2025 MCBS FAQ MCBSFAQ.pdf Supplementary Document 11/19/2025 Based FAQ BaseFAQEnclosure.pdf Supplementary Document 11/19/2025 Base Thank you Letter BaseThankYouLetter.pdf Supplementary Document 11/19/2025 Community Language Insert ComLanguageInsert.pdf Supplementary Document 11/19/2025 Facility Advance Letter Billing Offices FacAdvLetterBillOffices.pdf Supplementary Document 11/19/2025 Facility Prepare Interview Letter FacPrepInterviewLetter.pdf Supplementary Document 11/19/2025 Facility Thank You Letter FacThankYouLetter.pdf Supplementary Document 11/19/2025 Health Care Statement Gaining Cooperation Letter HCStatementGPLetter.pdf Supplementary Document 11/19/2025 Non Response Letter Fraud NonResponseLetterFraud.pdf Supplementary Document 11/19/2025 Response to comments document (60-day Responses to Public Comments.docx Supplementary Document 11/19/2025 Crosswalk (60-30day) 2026 Full Clearance 30-Day Crosswalk.pdf Supplementary Document 11/19/2025 Public Comments Author Name Comment Document Author Affiliation Sponsoring Org. Type Category Date of Comment Date Comment Received Coe, Norma CMS-2025-0337-DRAFT-0001 (1).html.pdf Email Simple 09/03/2025 09/03/2025 Chan, Denny Justice in Aging.pdf Managing Director, Equity Advocacy Justice in Aging Email Simple 09/12/2025 09/12/2025 Anonymous mapresearch.pdf Mapresearch Email Simple 09/12/2025 09/12/2025