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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 CMS-P-0015A Cost Payment Summary 2024_Cost_Payment_Summary_CPS.pdf Yes Yes Fillable Fileable
Form CMS-P-0015A Demographic Income 2026_Demographics_Income_DIQ.pdf Yes Yes Fillable Fileable
Form CMS-P-0015A End Questionaire 2024_End_END.pdf Yes Yes Fillable Fileable
Form CMS-P-0015A Enumeration Summary 2024_Enumeration_Summary_ENS.pdf Yes Yes Fillable Fileable
Form CMS-P-0015A Mobility of Beneficiaries 2024_Mobility_MBQ.pdf Yes Yes Fillable Fileable
Form CMS-P-0015A Post Statement Cost 2024_Post_Statement_Cost_PSQ.pdf Yes Yes Fillable Fileable
Form CMS-P-0015A Access to Care 2024_Access_to_Care_ACQ.pdf Yes Yes Fillable Fileable
Form CMS-P-0015A Chronic Pain 2024_Chronic_Pain_CPQ.pdf Yes Yes Fillable Fileable
Form CMS-P-0015A Dental, Vision, and Hearing Care Utilization 2024_Den_Vis_Hear_Care_Utl_DVH.pdf Yes Yes Fillable Fileable
Form CMS-P-0015A Drug Coverage 2026_Drug_Coverage_RXQ.pdf Yes Yes Fillable Fileable
Form CMS-P-0015A Emergency Utilization 2024_Emergency_Utilization_ERQ.pdf Yes Yes Fillable Fileable
Form CMS-P-0015A Health Insurance 2026_Health_Insurance_HIQ.pdf Yes Yes Fillable Fileable
Form CMS-P-0015A Home Health 2024_Home_Health_Util_HHQ.pdf Yes Yes Fillable Fileable
Form CMS-P-0015A Housing_Characteristics 2024_Housing_Charcs_HAQ.pdf Yes Yes Fillable Fileable
Form CMS-P-0015A Income_and_ Assets 2026_Income_and_Assets_IAQ.pdf Yes Yes Fillable Fileable
Form CMS-P-0015A Inpatient Utilization 2024_Inpatient_Utilization_IPQ.pdf Yes Yes Fillable Fileable
Form CMS-P-0015A Institutional Utilization 2024_Institutional_Util_IUQ.pdf Yes Yes Fillable Fileable
Form CMS-P-0015A Introduction 2026_Introduction_INQ.pdf Yes Yes Fillable Fileable
Form CMS-P-0015A Medical Provider Utilzation 2024_Medical_Provider_Util_MPQ.pdf Yes Yes Fillable Fileable
Form CMS-P-0015A Nicotine Alcohol 2024_Nicotine_Alcohol_Use_NAQ.pdf Yes Yes Fillable Fileable
Form CMS-P-0015A No Statement Cost 2024_No_Statement_Cost_NSQ.pdf Yes Yes Fillable Fileable
Form CMS-P-0015A Other Medical Expense 2024_Other_Medical_Expense_OMQ.pdf Yes Yes Fillable Fileable
Form CMS-P-0015A Outpatient Utilization 2023_Outpatient_Utilization_OPQ.pdf Yes Yes Fillable Fileable
Form CMS-P-0015A Prescribed Medicine Utilization 2024_Prescribed_Med_Util_PMQ.pdf Yes Yes Fillable Fileable
Form CMS-P-0015A Satisfaction Care 2026_Satisfaction_Care_SCQ.pdf Yes Yes Fillable Fileable
Form CMS-P-0015A Statement Cost Series 2024_Statement_Cost_Series_STQ.pdf Yes Yes Fillable Fileable
Form CMS-P-0015A Beneficiary Knowledge 2026_Beneficiary_Knowledge_KNQ.pdf Yes Yes Fillable Fileable
Form CMS-P-0015A Preventive Care 2026_Preventive_Care_PVQ.pdf Yes Yes Fillable Fileable
Form CMS-P-0015A Usual Source of Care 2026_Usual_Source_Of_Care_USQ.pdf Yes Yes Fillable Fileable
Form CMS-P-0015A Showcards and Reference Cards 2026CommShowcards508.pdf Yes Yes Fillable Fileable
Form CMS-P-0015A Facility Showcards 2026FacilityShowcards508.pdf Yes Yes Fillable Fileable
Form CMS-P-0015A Facility Screener Attachment 3. Fac2024_Facility_Screener_FACSCREEN.pdf Yes Yes Fillable Fileable
Form CMS-P-0015A Residence History Missing Data Fac2024_Residence_Missing_RHM.pdf Yes Yes Fillable Fileable
Form CMS-P-0015A Residence History Fac2024_Residence_History_RH.pdf Yes Yes Fillable Fileable
Form CMS-P-0015A Health_Status Fac2025_Health_Status_HS.pdf Yes Yes Fillable Fileable
Form CMS-P-0015A Background_Questionnaire Fac2024_Background_BQ.pdf Yes Yes Fillable Fileable
Form CMS-P-0015A Background_Questionnaire MIssing Data Fac2024_Background_Missing_BQM.pdf Yes Yes Fillable Fileable
Form CMS-P-0015A Expenditures Fac2024_Expenditures_EX.pdf Yes Yes Fillable Fileable
Form CMS-P-0015A Questionaire Missing Data Fac2024_Facility_Missing_FQM.pdf Yes Yes Fillable Fileable
Form CMS-P-0015A Questionaire Fac2024_Facility_Quex_FQ.pdf Yes Yes Fillable Fileable
Form CMS-P-0015A Health_Insurance Fac2024_Health_Insurance_IN.pdf Yes Yes Fillable Fileable
Form CMS-P-0015A Cognitive Measures 2026_Cognitive_Measures_CMQ.pdf Yes Yes Fillable Fileable
Form CMS-P-0015A HFQ - Health Status and Functioning 2025_Health_Status_HFQ.pdf Yes Yes Fillable Fileable
Form CMS-P-0015A Use of Health Services Section Specifications Fac2024_Use_Health_Services_US.pdf Yes Yes Fillable Fileable
Form CMS-P-0015A Telemedicine Questionnaire 2024_Telemedicine_TLQ.pdf Yes Yes Fillable Fileable
Form CMS-P-0015A Immunization 2026_Immunization_IMQ.pdf Yes Yes Fillable Fileable
Form CMS-P-0015A Health_Status 2026_Health_Status_HFQ.pdf Yes Yes Fillable Fileable
Form CMS-P-0015A Interviewer_Remarks Fac2024_Interviewer_Remarks_IR.pdf Yes Yes Fillable Fileable
Form CMS-P-0015A Debt Questionaire 2026_Debt_DBQ.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

13,568 0
   
Individuals or Households
 
   100 %

  Requested 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 35,015 0 0 0 0 35,015
Annual IC Time Burden (Hours) 32,258 0 -2,948 0 0 35,206
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Item Crosswalk (60-day) 2026 MCBS Item Revision Crosswalk_06242025.pdf 11/19/2025
Item Crosswalk (30-day) Item Level Crosswalk_09292025.pdf 11/19/2025
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.