Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)

Created 05/02/02

IA1a

Annual Household Income

A. Less than $5,000

G. $30,000 – 34,999

B. $5,000 – 9,999

H. $35,000 – 39,999

C. $10,000 – 14,999

I. $40,000 – 44,999

D. $15,000 – 19,999

J. $45,000 – 49,999

E. $20,000 – 24,999

K. $50,000 +

F. $25,000 – 29,999

Created 05/02/02

IA1a – cont’d

Monthly Household Income
A. Less than $417

G. $2,500 – 2,916

B. $417 – 833

H. $2,917 – 3,333

C. $834 – 1,249

I. $3,334 – 3,749

D. $1,250 – 1,666

J. $3,750 – 4,166

E. $1,667 – 2,083

K. $4,167 +

F. $2,084 – 2,499