Medicare Current Beneficiary Survey (MCBS)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Non-Substantive Change - Facility Three Rounds (2).docx	Justification for No Material/Nonsubstantive Change	Uploaded 2012-02-06	Available
MCBSConfidentialityAgreement.pdf	Supplementary Document	Uploaded 2012-02-06	Available
2010AdvanceLetterwithletterhead.pdf	Supplementary Document	Uploaded 2012-02-06	Available
Attachment 3 - UPDAttheDoorBrochure2010.pdf	Supplementary Document	Uploaded 2010-12-17	Available
Attachment 3 - UPDMCBSBrochure.pdf	Supplementary Document	Uploaded 2010-12-17	Available
attachment 10.zip	Supplementary Document	Uploaded 2010-08-25	Repair queued
attachment 08.zip	Supplementary Document	Uploaded 2010-08-25	Repair queued
attachment 07.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	Repair queued
MCBS Supporting Statement - Part A 02_03_2012.docx	Supporting Statement A	Uploaded 2012-02-06	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
8171	Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)	Other-English Showcards	Modified

ICR Details

OMB Control No: 0938-0568	ICR Reference No: 201202-0938-008
Status: Historical Active	Previous ICR Reference No: 201008-0938-025
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Medicare Current Beneficiary Survey (MCBS)
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 03/13/2012
	Date Received in OIRA: 02/29/2012
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2013	12/31/2013	12/31/2013
Responses	48,651	0	48,650
Time Burden (Hours)	58,450	0	57,062
Cost Burden (Dollars)	0	0	0

---

Abstract: The Medicare Current Beneficiary Survey (MCBS) is a continuous, multipurpose survey of a nationally representative sample of aged, disabled, and institutionalized Medicare beneficiaries. MCBS, which is sponsored by the Centers for Medicare & Medicaid Services (CMS), is the only comprehensive source of information on the health status, health care use and expenditures, health insurance coverage, and socioeconomic and demographic characteristics of the entire spectrum of Medicare beneficiaries. The core of the MCBS is a series of interviews with a stratified random sample of the Medicare population, including aged and disabled enrollees, residing in the community or in institutions. Questions are asked about enrollees' patterns of health care use, charges, insurance coverage, and payments over time. Respondents are asked about their sources of health care coverage and payment, their demographic characteristics, their health and work history, and their family living circumstances. In addition to collecting information through the core questionnaire, the MCBS collects information on special topics through supplements. For example, questions are asked about enrollees' income and assets, access to health care, health and functional status and satisfaction with care. Special supplements also focus on emerging trends in health care.

---

Authorizing Statute(s): PL: Pub.L. 108 - 173 722(b)(1) Name of Law: Medicare Prescription Drug, Improvement, and Modernization Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)

---

ICR Summary of Burden

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	48,651	48,650	0	1	0	0
Annual Time Burden (Hours)	58,450	57,062	0	1,388	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government: $16,210,970

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 02/29/2012

---