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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 MCBS AVQ.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-P-0015A MCBS CLQ.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-P-0015A MCBS CPS.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-P-0015A MCBS DIQ.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-P-0015A MCBS DUQ.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-P-0015A MCBS END.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-P-0015A MCBS ENS.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-P-0015A MCBS ERQ.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-P-0015A MCBS EXQ.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-P-0015A MCBS HAQ.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-P-0015A MCBS HFQ.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-P-0015A MCBS HHQ.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-P-0015A MCBS HHS.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-P-0015A MCBS HIQ.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-P-0015A MCBS HIS.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-P-0015A MCBS IAQ.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-P-0015A MCBS INQ.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-P-0015A MCBS IPQ.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-P-0015A MCBS IUQ.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-P-0015A MCBS KNQ.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-P-0015A MCBS MBQ.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-P-0015A MCBS MPQ.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-P-0015A MCBS NAQ.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-P-0015A MCBS NSQ.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-P-0015A MCBS OMQ.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-P-0015A MCBS OPQ.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-P-0015A MCBS PAQ.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-P-0015A MCBS PMQ.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-P-0015A MCBS PMS.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-P-0015A MCBS PSQ.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-P-0015A MCBS PVQ.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-P-0015A MCBS R76 Showcards_Combined_08.03.16.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-P-0015A MCBS RXQ.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-P-0015A MCBS SCQ.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-P-0015A MCBS STQ.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-P-0015A MCBS USQ.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-P-0015A MCBS Attachment 5 Facility Eligibility Screener.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-P-0015A MCBS Attachment 6 Facility Showcards.pdf Yes Yes Fillable Fileable
Instruction Global Displays_06.00.0000.xlsx Yes Yes Fillable Fileable
Instruction Medicaid Display List_06.00.0000.xlsx Yes Yes Fillable Fileable
Instruction Preload variables for PERS table_06.00.0000.xlsx Yes Yes Fillable Fileable
Form and Instruction CMS-P-0015A MCBS R69_BQF.docx Yes Yes Fillable Fileable
Form and Instruction CMS-P-0015A MCBS R69_BQM.docx Yes Yes Fillable Fileable
Form and Instruction CMS-P-0015A MCBS R69_BRF.docx Yes Yes Fillable Fileable
Form and Instruction CMS-P-0015A MCBS R69_EXF.docx Yes Yes Fillable Fileable
Form and Instruction CMS-P-0015A MCBS R69_FQF.docx Yes Yes Fillable Fileable
Form and Instruction CMS-P-0015A MCBS R69_FQM.docx Yes Yes Fillable Fileable
Form and Instruction CMS-P-0015A MCBS R69_HSF.docx Yes Yes Fillable Fileable
Form and Instruction CMS-P-0015A MCBS R69_INF.docx Yes Yes Fillable Fileable
Form and Instruction CMS-P-0015A MCBS R69_IRF.docx Yes Yes Fillable Fileable
Form and Instruction CMS-P-0015A MCBS R69_NVF.docx Yes Yes Fillable Fileable
Form and Instruction CMS-P-0015A MCBS R69_PMF.docx Yes Yes Fillable Fileable
Form and Instruction CMS-P-0015A MCBS R69_PRF.docx Yes Yes Fillable Fileable
Form and Instruction CMS-P-0015A MCBS R69_RHF.docx Yes Yes Fillable Fileable
Form and Instruction CMS-P-0015A MCBS R69_RHM.docx Yes Yes Fillable Fileable
Form and Instruction CMS-P-0015A MCBS R69_SRF.docx Yes Yes Fillable Fileable
Form and Instruction CMS-P-0015A MCBS R69_USF.docx Yes Yes Fillable Fileable
Instruction State Table for help file__06.00.0000.xlsx 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) 60,103 0 0 1,653 0 58,450
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.