Information Collection Request

Medicare Current Beneficiary Survey (MCBS)

ICR 201008-0938-025 · OMB 0938-0568 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-P-0015A Medicare Current Beneficiary Survey (MCBS): Rounds 48-56 (CMS Number CMS-P-0015A) Form and Instruction Removed Repair queued
UPDAttachments TOC.docx Supplementary Document Uploaded 2010-12-17 Available
Attachment 3 - UPDMCBSBrochure.pdf Supplementary Document Uploaded 2010-12-17 Available
Attachment 3 - UPDAttheDoorBrochure2010.pdf Supplementary Document Uploaded 2010-12-17 Available
Attachment 12 - SOR.MCBS.FED.REG.2006.pdf Supplementary Document Uploaded 2010-12-17 Available
CMS Response.docx Supplementary Document Uploaded 2010-12-17 Available
SupportingStatementPartB.pdf Supporting Statement B Uploaded 2010-08-25 Available
04-MCBS Confidentiality Agreement.pdf Supplementary Document Uploaded 2007-02-09 Available
04-MCBS Brochure.pdf Supplementary Document Uploaded 2007-02-09 Available
04-MCBS At the Door Sheet.pdf Supplementary Document Uploaded 2007-02-09 Available
04-CMS Advance Letter with letterhead.pdf Supplementary Document Uploaded 2007-02-09 Available
06-2007 Continuing.pdf Supplementary Document Uploaded 2007-02-09 Available
06-2006-2007 Supplemental.pdf Supplementary Document Uploaded 2007-02-09 Available
attachment 06.pdf Supplementary Document Uploaded 2007-02-09 Available
attachment 11.zip Supplementary Document Uploaded 2010-08-25 Available
attachment 10.zip Supplementary Document Uploaded 2010-08-25 Available
attachment 09.zip Supplementary Document Uploaded 2010-08-25 Available
attachment 08.zip Supplementary Document Uploaded 2010-08-25 Available
attachment 07.zip Supplementary Document Uploaded 2010-08-25 Available
Attachments TOC.pdf Supplementary Document Uploaded 2010-08-25 Available
attachment 03.zip Supplementary Document Uploaded 2010-08-25 Repair queued
attachment 02.zip Supplementary Document Uploaded 2010-08-25 Repair queued
attachment 01.zip Supplementary Document Uploaded 2010-08-25 Available
UPDSupportingStatementPartA.docx Supporting Statement A Uploaded 2010-12-17 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
8171 Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A) Other-Spanish Version Modified
178995 Medicare Current Beneficiary Survey (MCBS): Rounds 48-56 (CMS Number CMS-P-0015A) Form and Instruction Removed

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
12/31/2013 36 Months From Approved 12/31/2010
48,650 0 49,500
57,062 0 50,325
0 0 0





table that charts list 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 48,650 49,500 0 -850 0 0
Annual Time Burden (Hours) 57,062 50,325 0 6,737 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No