View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Facility Screening Interview Script for Meeting with Facility Administrators Yes Yes Printable Only
Other-MCBS Facility Round 55 Instrument Yes Yes Printable Only
Other-CQuestionnaire Layout Yes Yes Printable Only
Other-Spanish Yes Yes Printable Only
Other-Spanish Yes Yes Printable Only
Other-Spanish Yes Yes Printable Only
Other-Spanish Yes Yes Printable Only
Other-Spanish Yes Yes Printable Only
Other-Spanish Yes Yes Printable Only
Other-Spanish Yes Yes Printable Only
Other-Spanish Yes Yes Printable Only
Other-Spanish Yes Yes Printable Only
Other-Spanish Yes Yes Printable Only
Other-Spanish Yes Yes Printable Only
Other-Spanish Yes Yes Printable Only
Other-Spanish Yes Yes Printable Only
Other-Spanish Yes Yes Printable Only
Other-Spanish Yes Yes Printable Only
Other-Spanish Yes Yes Printable Only
Other-Spanish Yes Yes Printable Only
Other-Spanish Yes Yes Printable Only
Other-Spanish Yes Yes Printable Only
Other-Spanish Yes Yes Printable Only
Other-Spanish Yes Yes Printable Only
Other-Spanish Yes Yes Printable Only
Other-Spanish Yes Yes Printable Only
Other-Spanish Yes Yes Printable Only
Other-Spanish Yes Yes Printable Only
Other-Spanish Yes Yes Printable Only
Other-Spanish Yes Yes Printable Only
Other-Spanish Yes Yes Printable Only
Other-Spanish Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-Spanish Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-English Showcards Yes Yes Printable Only
Other-Section By Section Yes Yes Printable Only
Other-Section By Section Yes Yes Printable Only
Other-Section By Section Yes Yes Printable Only
Other-Section By Section Yes Yes Printable Only
Other-Section By Section Yes Yes Printable Only
Other-Section By Section Yes Yes Printable Only
Other-Section By Section Yes Yes Printable Only
Other-Section By Section Yes Yes Printable Only
Other-Section By Section Yes Yes Printable Only
Other-Section By Section Yes Yes Printable Only
Other-Section By Section Yes Yes Printable Only
Other-Section By Section Yes Yes Printable Only
Other-Section By Section Yes Yes Printable Only
Other-Section By Section Yes Yes Printable Only
Other-Section By Section Yes Yes Printable Only
Other-Section By Section Yes Yes Printable Only
Other-Section By Section Yes Yes Printable Only
Other-Section By Section Yes Yes Printable Only
Other-Section By Section Yes Yes Printable Only
Other-Section By Section Yes Yes Printable Only
Other-Section By Section Yes Yes Printable Only
Other-Section By Section Yes Yes Printable Only
Other-Section By Section Yes Yes Printable Only
Other-Section By Section Yes Yes Printable Only
Other-Section By Section Yes Yes Printable Only
Other-Section By Section Yes Yes Printable Only
Other-Section By Section Yes Yes Printable Only
Other-Section By Section Yes Yes Printable Only
Other-Section By Section Yes Yes Printable Only
Other-Section By Section Yes Yes Printable Only
Other-Section By Section Yes Yes Printable Only
Other-Section By Section Yes Yes Printable Only
Other-Section By Section Yes Yes Printable Only
Other-Section By Section Yes Yes Printable Only
Other-Section By Section Yes Yes Printable Only
Other-Section By Section Yes Yes Printable Only
Other-Section By Section Yes Yes Printable Only
Other-Roster Yes Yes Printable Only
Other-Roster Yes Yes Printable Only
Other-Roster Yes Yes Printable Only
Other-Roster Yes Yes Printable Only
Other-Roster Yes Yes Printable Only
Other-Roster Yes Yes Printable Only
Other-Roster Yes Yes Printable Only
Other-Roster Yes Yes Printable Only
Other-Roster Yes Yes Printable Only
Other-Roster Yes Yes Printable Only
Other-Roster Yes Yes Printable Only
Other-Roster Yes Yes Printable Only
Other-Roster Yes Yes Printable Only
Other-General Specifications Yes Yes Printable Only
Other-General Specifications Yes Yes Printable Only
Other-General Specifications Yes Yes Printable Only
Other-General Specifications Yes Yes Printable Only
Other-General Specifications Yes Yes Printable Only
Other-General Specifications Yes Yes Printable Only
Other-General Specifications Yes Yes Printable Only
Other-General Specifications Yes Yes Printable Only
Other-General Specifications Yes Yes Printable Only
Other-General Specifications Yes Yes Printable Only
Other-General Specifications Yes Yes Printable Only
Other-General Specifications Yes Yes Printable Only
Other-Entire Questionnaire Condensed Yes Yes Printable Only

Health Health Care Services

 

16,217 0
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 48,651 0 1 0 0 48,650
Annual IC Time Burden (Hours) 58,450 0 1,388 0 0 57,062
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
attachment 01 08/25/2010
attachment 02 08/25/2010
attachment 07 08/25/2010
attachment 08 08/25/2010
attachment 10 08/25/2010
Attachment 3 - UPDMCBSBrochure 12/17/2010
Attachment 3 - UPDMCBSBrochure 12/17/2010
2010AdvanceLetterwithletterhead 02/06/2012
MCBSConfidentialityAgreement 02/06/2012
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
Something went wrong when downloading this file. If you have any questions, please send an email to risc@gsa.gov.