Medicare Current Beneficiary Survey (MCBS): Rounds 48-56 (CMS Number CMS-P-0015A)

Medicare Current Beneficiary Survey (MCBS): Rounds 48-56 (CMS Number CMS-P-0015A)

OMB: 0938-0568

IC ID: 8171

Documents and Forms

Document Name Document Type
Form CMS-P-0015A Medicare Current Beneficiary Survey (MCBS): Rounds 48-56 (CMS Number CMS-P-0015A) Form and Instruction
CMS-P-0015A Background Questionnaire 08-F_Background_BQ.pdf Form and Instruction
CMS-P-0015A MCBS Facility Round 46 Expenditure Questionnaire 08-F_Expenditures_EX.pdf Form and Instruction
CMS-P-0015A MCBS Facility Round 46 Health Ins Questionnaire 08-F_Health Insurance_IN.pdf Form and Instruction
CMS-P-0015A MCBS Facility Round 46 Health Status Base Line 08-F_Health Status_HS.pdf Form and Instruction
CMS-P-0015A MCBS Facility Round 46 Resident History 08-F_Residence History_RH.pdf Form and Instruction
CMS-P-0015A MCBS Facility Round 46 Prescription Medicines 08-F_Prescribed Medicines_PM.pdf Form and Instruction
CMS-P-0015A MCBS Facility Round 46 Use of Services Module 08-F_Use of Health Care Services_US.pdf Form and Instruction
CMS-P-0015A Facility Screening Interview Script 07-F_Facility Questionnaire_FQ.pdf Form and Instruction
CMS-P-0015A MCBS Household Round 46 Questionnaire English 05-Questionnaire English.zip Form and Instruction
CMS-P-0015A MCBS Household Round 46 Questionnaire Spanish 05-Questionnaire Spanish.zip Form and Instruction
CMS-P-0015A MCBS Household Round 46 Show Cards 05-Showcards.zip Form and Instruction
attachment 06.pdf MCBS Calendars for Supplemental and Continuing Samples IC Document
06-2006-2007 Supplemental.pdf Calendar for Supplemental Samples IC Document
06-2007 Continuing.pdf Calendar for Continuing Samples IC Document
04-CMS Advance Letter with letterhead.pdf Advance Letter IC Document
04-MCBS At the Door Sheet.pdf At the door sheet IC Document
04-MCBS Brochure.pdf MCBS Brochure IC Document
04-MCBS Confidentiality Agreement.pdf Confidentiality Agreement IC Document