Computerized Automated Personal Interviewing (CAPI) Conversion of the Medicare Current Beneficiary Survey (MCBS) Facility Questionnaire (CAPI Conversion of MCBS Facility Questionnaire)

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Documents and Forms

Document Name Document Type

no available documents/forms check other ICs listed under this ICR

Information Collection (IC) Details

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IC Title:	Computerized Automated Personal Interviewing (CAPI) Conversion of the Medicare Current Beneficiary Survey (MCBS) Facility Questionnaire (CAPI Conversion of MCBS Facility Questionnaire)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	HCFA-P-15A				Yes	Yes

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,900	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,900	-14,100	16,000
Annual IC Time Burden (Hours)	16,000	0	16,000
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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