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
Form and Instruction CMS-P-0015A Attachment 5 - Facility Screener Facility Screener May 2012.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-P0015A Attachment 6 - MCBS Faclility Round 64 Instruments attachment 6.zip Yes Yes Fillable Fileable
Form and Instruction CMS-P0015A Attachment 8 - Verification Re-interview ValidationInterviewCommunityComponent.zip Yes Yes Fillable Fileable
Form and Instruction CMS-P0015A MCBS Household Round 67 Instruments Attachment 4.zip Yes Yes Fillable Fileable
Form and Instruction CMS-P0015A General Specifications Screen Types_19.01.0001 General Specifications Screen Types_19.01.0001.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-P0015A General Specifications Spanish Text_19.01.001 General Specifications Spanish Text_19.01.001.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-P0015A Spanish Folder General Specifications Spanish Text_19.01.001 General Specifications Spanish Text_19.01.001.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-P0015A English Showcards HI-Eng HI-Eng.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-P0015A Spanish Showcars KN-Sp KN-Sp.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-P0015A English Section by Section CPS_16.01.0002 CPS_16.01.0002.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-P0015A English Section by Section ENS_10.01.0001 ENS_10.01.0001.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-P0015A English Section by Section HF_10.01.0002 HF_10.01.0002.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-P0015A English Section by Section HI_17.01.0002 HI_17.01.0002.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-P0015A English Section by Section HIS_13.01.0001 HIS_13.01.0001.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-P0015A English Section by Section IA_08.01.0000 IA_08.01.0000.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-P0015A English Section by Section IN_12.01.0000 IN_12.01.0000.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-P0015A English Section by Section KN_05.01.0002 KN_05.01.0002.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-P0015A English Section by Section NS_18.01.0000.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-P0015A English Section by Section OM_09.01.0000.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-P0015A English Section by Section PM_14.01.0001.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-P0015A English Section by Section RX_07.01.0000.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-P0015A English Section by Section SC_09.01.0000.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-P0015A English Section by Section ST_15.01.0001.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-P0015A MCBS Round 73 Questionnaires Round 73 Questionnaires.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

16,550 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 49,650 0 0 0 0 49,650
Annual IC Time Burden (Hours) 58,450 0 0 0 0 58,450
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Table of Contents Attachments TOC.pdf 10/25/2013
Attachment 2 - Publications attachment 2.zip 10/25/2013
Attachment 3 - Letter, Brochure, Agreement Attachment 3.zip 10/25/2013
Attachment 7 - Consent Forms attachment07.pdf 10/25/2013
Attachment 9 - Impact of Nonsresponse on MCBS Estimates attachment09.pdf 10/25/2013
Attachment 10 - Primary Sampling Unit Breakdown attachment10.pdf 10/25/2013
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.