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

Created 6117/08

Current

Beneficiary

Survey

MeBS
Armenian

Chinese

D
D

Make kazye sa a si ou Ii oswa ou pale kreyol ayisyen.

Creole

Zaskrtnete tuto kolonku, pokud ctete a hovonte cesky.

Czech

Farsi

D
D

D

D

Cocher ici si vous lisez ou parlez Ie

fran~ais.

French

Kreuzen Sie dieses Kastchen an, wenn Sie Deutsch lesen oder sprechen.

German

:I:TlIlEtcOOtE auto to 1tA.aimo av Ota~OSEtE " IltA.OtE EA.A.TlVtlCO.

Greek

Kos lub voj no yog koj paub twm thiab hais Ius Hmoob.

Hmong

WESTAT
AN EMVLOHE OWNED
RESEARCH CORPORATION

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Marchi questa casella se legge 0 parla italiano.

Italian

Japanese

Korean

Laotian

D

D

Zaznacz t~

kratk~jezeli

czyta Pan/pani lub m6wi po polsku.

Assinale este quadrado se voce Ie ou fala Portugues.

Portuguese

TIoMeThTe 3TOT KBaApaTHK, eCJIH BhI qHTaeTe HJIH rOBopHTe no-pyccKH.

Russian

Marque esta casilla si lee 0 habla espano!.

Spanish

Markahan ang kahon na ito kung ikaw ay nagsasalita 0 nagbabasa ng Tagalog.

Tagalog

D

D

D

Polish

Thai

D
D
D
D

BiAMiThTe U;IO KJIiTHHKY, SlKID;O BH qHTa€Te a60 roBopHTe
YKpalHchKoIO MOBOIO.

Ukrainian

'cYiSJ c,w.. ~ .... l.i.. 1.,)"1,j:. v:f ~~ l:! ~~~) ,,;,,1 fil

Urdu

Xin danh dau vao () nay neu quy biet dQc va n6i dUQ'C Vi¢t Ngu.

Vietnamese

.UPT'N np'/llJTN

~J."lW

l'N J.'lN ,nUlJj7 DlJT

n]J"~

Yiddish

lTAT
EE-OWNED
)HORATION