Attachment 3 - UPDAttheDoorBrochure2010

The Medicare Current
Beneficiary Survey
A Few Reasons Why It Is Important
For You To Participate In The MCBS:
n

To improve Medicare for future generations.

n

To improve the quality of care.

n

To improve future laws and regulations
for people enrolled in Medicare.

Your participation is voluntary.
Your Medicare Benefits will not be affected
in any way by your answers or your decision
to participate.

This survey is authorized by section 1875
(42 USC 139511) of the Social Security Act and
is conducted by Westat for the U.S. Department
of Health and Human Services, Health Care
Financing Administration.

Some Facts for People Who Are Part of the MCBS:
n You will be making an important contribution toward improving health care for people on

Medicare. The MCBS is planned to continue over the next several years. We will talk to
people who are part of the MCBS a few times each year.
n The information you provide will be kept in strict

confidence under the Privacy Act of 1974. Information
cannot be disclosed in any form that would permit
identification of an individual in this study, except to
those involved in this research or for routine use or in very
limited circumstances as prescribed by the Privacy Act.
n Your responses will be used in tables and graphs along

with the data from others. Your data could be carefully
verified by computer matching under Public Law 100-503
[The Computer Matching and Privacy Protect Act].
n According to the Paperwork Reduction Act of 1995,

no persons are required to respond to a collection of
information unless it displays a valid OMB control number.
The valid OMB control number for this information
collection is 0938-0568. The time required to complete
this information collection is estimated to average 1 hour
for the first interview and approximately 1-1/2 hours for
subsequent interviews. This includes the time to review
instructions, gather the data needed, and complete and
review the information collection. Additionally, a random
percentage of the respondent population (per round) is
contacted for a validation interview averaging 5 minutes.
If you have any comments concerning the accuracy of the time estimate(s) or suggestions for
improving this form, please write to: CMS, C5-14-03, 7500 Security Boulevard, Baltimore,
Maryland 21244-1850.

Let’s Improve Health Care — Talk to Your Interviewer
Current
Beneficiary
Survey

U.S. Department of HealtH
anD HUman ServiceS
Health Care Financing Administration
Administered by: Westat

30230.0610.867005