Attachments TOC

Medicare Current Beneficiary Survey

Attachments

Attachment 1:

Cross Walk of Changes to Survey

Attachment 2:

Publications

Attachment 3:

Advance Letter
MCBS Brochure and Introduction to MCBS Sheet
Confidentiality Agreement

Attachment 4:

MCBS Household Round 55 Instruments to Include:
A) Questionnaire Layout
B) English
1) Entire Questionnaire in Condensed Format
2) Entire Questionnaire in Comprehensive Format
a) Section by Section
b) General Specifications
c) Rosters
3) Show Cards
C) Spanish
1) Questionnaire
2) Show Cards

Attachment 5:

Facility Screening Interview Script for Meeting with Facility
Administrators (Included is the Facility Questionnaire Layout)

Attachment 6:

MCBS Facility Round 55 Instrument to Include:
A) Facility Questionnaire Layout
B) Section by Section Questionnaire

Attachment 7:

Consent forms: Resident and Next of Kin Authorization to Obtain
Information from Medical Records

Attachment 8:

Verification Re-interview

Attachment 9:

“Impact of Nonresponse on Medicare Current Beneficiary Survey
Estimates”

Attachment 10: “Overview of the Medicare Current Beneficiary Study Redesign
Evaluation Task”
Attachment 11: Primary Sampling Unit Breakdown: State, County and City

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