View Information Collection Request (ICR) Package
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Common Form Info.
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View Information Collection (IC) List
View Supporting Statement and Other Documents
Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
0938-0568
ICR Reference No:
202006-0938-011
Status:
Historical Active
Previous ICR Reference No:
202002-0938-004
Agency/Subagency:
HHS/CMS
Agency Tracking No:
OEDA
Title:
Medicare Current Beneficiary Survey (MCBS) (CMS-P-0015A)
Type of Information Collection:
No material or nonsubstantive change to a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
06/15/2020
Retrieve Notice of Action (NOA)
Date Received in OIRA:
06/15/2020
Terms of Clearance:
Approved consistent with the understanding that CMS will conduct an analysis of whether there is a change in the characteristics of those responding before and after the change in mode administration, and discuss the results of this comparison whenever the MCBS 2020 findings are presented.
Inventory as of this Action
Requested
Previously Approved
Expiration Date
08/31/2022
08/31/2022
08/31/2022
Responses
35,998
0
35,998
Time Burden (Hours)
42,610
0
42,610
Cost Burden (Dollars)
0
0
0
Abstract:
The Medicare Current Beneficiary Survey (MCBS) is a continuous, multipurpose survey of a nationally representative sample of aged, disabled, and institutionalized Medicare beneficiaries. MCBS, which is sponsored by the Centers for Medicare & Medicaid Services (CMS), is the only comprehensive source of information on the health status, health care use and expenditures, health insurance coverage, and socioeconomic and demographic characteristics of the entire spectrum of Medicare beneficiaries.
Authorizing Statute(s):
PL:
Pub.L. 108 - 173 723
Name of Law: Medicare Prescription Drug, Improvement, and Modernization Act
PL:
Pub.L. 111 - 148 3021
Name of Law: Affordable Care Act
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
84 FR 731
01/31/2019
30-day Notice:
Federal Register Citation:
Citation Date:
84 FR 15617
04/16/2019
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
1
IC Title
Form No.
Form Name
Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)
CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A
Cost Payment Summary
,
Demographic Income
,
End Questionaire
,
Enumeration Summary
,
Home Health Summary
,
nterviewer Remarks
,
Mobility of Beneficiaries
,
Post Statement Cost
,
Access to Care
,
Chronic Pain
,
Dental, Vision, and Hearing Care Utilization
,
Drug Coverage
,
Emergency Utilization
,
Health Insurance
,
Home Health
,
Housing_Characteristics
,
Income_and_ Assets
,
Inpatient Utilization
,
Institutional Utilization
,
Introduction
,
Medical Provider Utilzation
,
Nicotine Alcohol
,
No Statement Cost
,
Other Medical Expense
,
Outpatient Utilization
,
Prescribed Medicine Utilization
,
Satisfaction Care
,
Statement Cost Series
,
Beneficiary Knowledge
,
Preventive Care
,
Usual Source of Care
,
Showcards and Reference Cards
,
Facility Showcards
,
Facility Screener
,
Residence History Missing Data
,
Residence History
,
Use of Health Services
,
Background_Questionnaire
,
Background_Questionnaire MIssing Data
,
Expenditures
,
Questionaire Missing Data
,
Questionaire
,
Health_Insurance
,
Health_Status
,
Health Status
ICR Summary of Burden
Total Approved
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in Estimate
Change Due to Potential Violation of the PRA
Annual Number of Responses
35,998
35,998
0
0
0
0
Annual Time Burden (Hours)
42,610
42,610
0
0
0
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
No
Burden Increase Due to:
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
Annual Cost to Federal Government:
$23,347,008
Does this IC contain surveys, censuses, or employ statistical methods?
Yes
Part B of Supporting Statement
Does this ICR request any personally identifiable information (see
OMB Circular No. A-130
for an explanation of this term)? Please consult with your agency's privacy program when making this determination.
No
Does this ICR include a form that requires a Privacy Act Statement (see
5 U.S.C. §552a(e)(3)
)? Please consult with your agency's privacy program when making this determination.
No
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
Yes
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
No
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Is this ICR related to the Pandemic Response?
Yes
Agency Contact:
Stephan McKenzie 410 786-1943 stephan.mckenzie@cms.hhs.gov
Common Form ICR:
No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date:
06/15/2020
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