Medicare Current Beneficiary Survey (MCBS): Rounds 20-28

ICR 199710-0938-007

OMB: 0938-0568

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
0938-0568 199710-0938-007
Historical Active 199702-0938-006
HHS/CMS
Medicare Current Beneficiary Survey (MCBS): Rounds 20-28
Revision of a currently approved collection   No
Regular
Approved without change 12/24/1997
Retrieve Notice of Action (NOA) 10/31/1997
  Inventory as of this Action Requested Previously Approved
04/30/2001 04/30/2001 09/30/1998
49,500 0 1,900
50,490 0 16,000
0 0 0

The Medicare Current Beneficiary Survey Questionnaire Rounds 20-28 collect cost and utilization data for community and industrial populations. Information collection includes: Inpatient hospitalization, emergency care, outpatient clinics, provider use, prescribed medications, and other medical equipment; cost, charges, sources of payment will be collected for each use.

None
None


No

1
IC Title Form No. Form Name
Medicare Current Beneficiary Survey (MCBS): Rounds 20-28 HCFA-P-15A

  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 49,500 1,900 0 47,600 0 0
Annual Time Burden (Hours) 50,490 16,000 0 34,490 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
No

$0
Yes Part B of Supporting Statement
No
Uncollected
Uncollected
Uncollected
Uncollected

  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
10/31/1997


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