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 Yes Yes Fillable Fileable
Form and Instruction CMS-P0015A Yes Yes Fillable Fileable
Form and Instruction CMS-P0015A Yes Yes Fillable Fileable
Form and Instruction CMS-P0015A Yes Yes Fillable Fileable
Form and Instruction CMS-P0015A Yes Yes Fillable Fileable
Form and Instruction CMS-P0015A Yes Yes Fillable Fileable
Form and Instruction CMS-P0015A Yes Yes Fillable Fileable
Form and Instruction CMS-P0015A Yes Yes Fillable Fileable
Form and Instruction CMS-P0015A Yes Yes Fillable Fileable
Form and Instruction CMS-P0015A Yes Yes Fillable Fileable
Form and Instruction CMS-P0015A Yes Yes Fillable Fileable
Form and Instruction CMS-P0015A Yes Yes Fillable Fileable
Form and Instruction CMS-P0015A Yes Yes Fillable Fileable
Form and Instruction CMS-P0015A Yes Yes Fillable Fileable
Form and Instruction CMS-P0015A Yes Yes Fillable Fileable
Form and Instruction CMS-P0015A Yes Yes Fillable Fileable
Form and Instruction CMS-P0015A Yes Yes Fillable Fileable
Form and Instruction CMS-P0015A Yes Yes Fillable Fileable
Form and Instruction CMS-P0015A Yes Yes Fillable Fileable
Form and Instruction CMS-P0015A Yes Yes Fillable Fileable
Form and Instruction CMS-P0015A Yes Yes Fillable Fileable
Form and Instruction CMS-P0015A Yes Yes Fillable Fileable
Form and Instruction CMS-P0015A Yes Yes Fillable Fileable
Form and Instruction CMS-P0015A 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 10/25/2013
Attachment 2 - Publications 10/25/2013
Attachment 3 - Letter, Brochure, Agreement 10/25/2013
Attachment 7 - Consent Forms 10/25/2013
Attachment 9 - Impact of Nonsresponse on MCBS Estimates 10/25/2013
Attachment 10 - Primary Sampling Unit Breakdown 10/25/2013
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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