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
Attachment 12: System of Records Notice
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | Medicare Health Outcomes Survey |
| Author | CMS |
| File Modified | 0000-00-00 |
| File Created | 2021-02-02 |