Information Collection
Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)
IC 8171 under ICR 201202-0938-008 · OMB 0938-0568.
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0568 can be found here:
Documents and Forms
| Document Name | Document Type |
|---|---|
attachment 05.zip
| Other-Facility Screening Interview S |
|
attachment 06.zip
| Other-MCBS Facility Round 55 Instrum |
CQuestionnaireLayout.pdf.pdf
| Other-CQuestionnaire Layout |
|
AC Round 55.pdf
| Other-Spanish |
|
CPS Round 55.pdf
| Other-Spanish |
|
DU Round 55.pdf
| Other-Spanish |
|
ER Round 55.pdf
| Other-Spanish |
|
HH & HHS Round 55.pdf
| Other-Spanish |
|
HIST & HIT Round 55.pdf
| Other-Spanish |
|
IU Round 55.pdf
| Other-Spanish |
|
NS Round 55.pdf
| Other-Spanish |
|
PM & PMS Round 55.pdf
| Other-Spanish |
|
AV Round 55.pdf
| Other-Spanish |
|
DI Round 52.pdf
| Other-Spanish |
|
EN & ENS Round 55.pdf
| Other-Spanish |
|
HA Round 55.pdf
| Other-Spanish |
|
HI & HIS Round 55.pdf
| Other-Spanish |
|
IN & INS Round 55.pdf
| Other-Spanish |
|
MC Round 55.pdf
| Other-Spanish |
|
OM Round 55.pdf
| Other-Spanish |
|
PS Round 55.pdf
| Other-Spanish |
|
STRound55.pdf
| Other-Spanish |
|
CL Round 55.pdf
| Other-Spanish |
|
DM Round 55.pdf
| Other-Spanish |
|
END Round 55.pdf
| Other-Spanish |
|
HF Round 55.pdf
| Other-Spanish |
|
HISMC & HIMC Round 55.pdf
| Other-Spanish |
|
IP Round 55.pdf
| Other-Spanish |
|
MP Round 55.pdf
| Other-Spanish |
|
OP Round 55.pdf
| Other-Spanish |
|
SCRound55.pdf
| Other-Spanish |
|
USRound55.pdf
| Other-Spanish |
|
DI2-Sp.pdf
| Other-Spanish Showcards |
|
DM1-Sp.pdf
| Other-Spanish Showcards |
|
glos-med abbrv dose-strength med-Spanish.pdf
| Other-Spanish Showcards |
|
HA3-Sp.pdf
| Other-Spanish Showcards |
|
HF3-Sp.pdf
| Other-Spanish Showcards |
|
HF6-Sp.pdf
| Other-Spanish Showcards |
|
HH2-Sp.pdf
| Other-Spanish Showcards |
|
HH5-Sp.pdf
| Other-Spanish Showcards |
|
HIMC1-Spanish.pdf
| Other-Spanish Showcards |
|
IA1-Sp.pdf
| Other-Spanish Showcards |
|
2010 Calendar-Spanish.pdf
| Other-Spanish Showcards |
|
DI3-Sp.pdf
| Other-Spanish Showcards |
|
DU-Sp.pdf
| Other-Spanish Showcards |
|
HA1-Sp.pdf
| Other-Spanish Showcards |
|
HF1-Sp.pdf
| Other-Spanish Showcards |
|
HF7-Sp.pdf
| Other-Spanish Showcards |
|
HH3-Sp.pdf
| Other-Spanish Showcards |
|
HI3-Sp _not match_.pdf
| Other-Spanish Showcards |
|
HIMC2A-Sp.pdf
| Other-Spanish Showcards |
|
HIT1_front & back_-Sp.pdf
| Other-Spanish Showcards |
|
IA2-Sp.pdf
| Other-Spanish Showcards |
|
DI1A-Sp.pdf
| Other-Spanish Showcards |
|
DI-Sp.pdf
| Other-Spanish Showcards |
|
ENS-Sp.pdf
| Other-Spanish Showcards |
|
HA2-Sp.pdf
| Other-Spanish Showcards |
|
HF2-Sp.pdf
| Other-Spanish Showcards |
|
HF5-Sp.pdf
| Other-Spanish Showcards |
|
HH1-Sp.pdf
| Other-Spanish Showcards |
|
HH4-Sp.pdf
| Other-Spanish Showcards |
|
HI4-Sp.pdf
| Other-Spanish Showcards |
|
HIMC2-SP.pdf
| Other-Spanish Showcards |
|
HIT2-Sp.pdf
| Other-Spanish Showcards |
|
IA3-Sp.pdf
| Other-Spanish Showcards |
|
IA3-Sp.pdf
| Other-Spanish Showcards |
|
KN1-Sp.pdf
| Other-Spanish Showcards |
|
KN6-Sp.pdf
| Other-Spanish Showcards |
|
KN13-Sp.pdf
| Other-Spanish Showcards |
|
MP2-Sp.pdf
| Other-Spanish Showcards |
|
MP5-Sp.pdf
| Other-Spanish Showcards |
|
OM3-Sp.pdf
| Other-Spanish Showcards |
|
PA1_PA2_PA4-Sp.pdf
| Other-Spanish Showcards |
|
PM1-Sp.pdf
| Other-Spanish Showcards |
|
RX1-Sp.pdf
| Other-Spanish Showcards |
|
SC1-Sp.pdf
| Other-Spanish Showcards |
|
SC4-Sp.pdf
| Other-Spanish Showcards |
|
ST2-Sp.pdf
| Other-Spanish Showcards |
|
US2-Sp.pdf
| Other-Spanish Showcards |
|
IU-Sp.pdf
| Other-Spanish Showcards |
|
KN4-Sp.pdf
| Other-Spanish Showcards |
|
KN9-Sp.pdf
| Other-Spanish Showcards |
|
MP1-Sp.pdf
| Other-Spanish Showcards |
|
MP4-Sp.pdf
| Other-Spanish Showcards |
|
OM2-Sp.pdf
| Other-Spanish Showcards |
|
OM5-Sp.pdf
| Other-Spanish Showcards |
|
PD2-Sp.pdf
| Other-Spanish Showcards |
|
ref card for med specialty-SP.pdf
| Other-Spanish Showcards |
|
SC1A-Sp.pdf
| Other-Spanish Showcards |
|
SC3-Sp.pdf
| Other-Spanish Showcards |
|
ST1-Sp.pdf
| Other-Spanish Showcards |
|
US1-Sp.pdf
| Other-Spanish Showcards |
|
IA4-Sp.pdf
| Other-Spanish Showcards |
|
KN2-Sp.pdf
| Other-Spanish Showcards |
|
KN7-Sp.pdf
| Other-Spanish Showcards |
|
KN14-Sp.pdf
| Other-Spanish Showcards |
|
MP3-Sp.pdf
| Other-Spanish Showcards |
|
OM1-Sp.pdf
| Other-Spanish Showcards |
|
OM4-Sp.pdf
| Other-Spanish Showcards |
|
PD1-Sp.pdf
| Other-Spanish Showcards |
|
pronunc guide-Sp.pdf
| Other-Spanish Showcards |
|
RX2-Sp.pdf
| Other-Spanish Showcards |
|
SC2-Sp.pdf
| Other-Spanish Showcards |
|
statement terms glos-Spanish.pdf
| Other-Spanish Showcards |
|
2010 Calendar-Eng.pdf
| Other-English Showcards |
|
DI3-Eng.pdf
| Other-English Showcards |
|
DU-Eng.pdf
| Other-English Showcards |
|
Exit Screens_Showcard.pdf
| Other-English Showcards |
|
HA2-Eng.pdf
| Other-English Showcards |
|
HF2-Eng.pdf
| Other-English Showcards |
|
HF5-Eng.pdf
| Other-English Showcards |
|
HH1-Eng.pdf
| Other-English Showcards |
|
HH4-Eng.pdf
| Other-English Showcards |
|
HI3 E-K.pdf
| Other-English Showcards |
|
HI3 O-S.pdf
| Other-English Showcards |
|
HIMC1-Eng.pdf
| Other-English Showcards |
|
HIMC-Eng.pdf
| Other-English Showcards |
|
IA1a-Eng.pdf
| Other-English Showcards |
|
IA Glossary.pdf
| Other-English Showcards |
|
IA2-Eng.pdf
| Other-English Showcards |
|
KN1-Eng.pdf
| Other-English Showcards |
|
KN6-Eng.pdf
| Other-English Showcards |
|
KN13-Eng.pdf
| Other-English Showcards |
|
MP1-Eng.pdf
| Other-English Showcards |
|
MP4-Eng.pdf
| Other-English Showcards |
|
OM2-Eng.pdf
| Other-English Showcards |
|
OM5-Eng.pdf
| Other-Spanish Showcards |
|
PD2-Eng.pdf
| Other-English Showcards |
|
R56 Continuing Showcard List.pdf
| Other-English Showcards |
|
RX2-Eng.pdf
| Other-English Showcards |
|
SC2-Eng.pdf
| Other-English Showcards |
|
spec keys for CAPI.pdf
| Other-English Showcards |
|
state abbrv.pdf
| Other-English Showcards |
|
US2-Eng.pdf
| Other-English Showcards |
|
DI1A-Eng.pdf
| Other-English Showcards |
|
DI-Eng.pdf
| Other-English Showcards |
|
ENS-Eng.pdf
| Other-English Showcards |
|
gloss of pres med abbrv.pdf
| Other-English Showcards |
|
HA3-Eng.pdf
| Other-English Showcards |
|
HF3-Eng.pdf
| Other-English Showcards |
|
HF6-Eng.pdf
| Other-English Showcards |
|
HH2-Eng.pdf
| Other-English Showcards |
|
HH5-Eng.pdf
| Other-English Showcards |
|
HI3 L-M.pdf
| Other-English Showcards |
|
HI3 T-W.pdf
| Other-English Showcards |
|
HIMC2A-Eng.pdf
| Other-English Showcards |
|
HIT1_front & back_-Eng.pdf
| Other-English Showcards |
|
IA1a-Sp.pdf
| Other-English Showcards |
|
IA3-Eng.pdf
| Other-English Showcards |
|
Interrupt Menu Showcard .pdf
| Other-English Showcards |
|
KN2-Eng.pdf
| Other-English Showcards |
|
KN7-Eng.pdf
| Other-English Showcards |
|
KN14-Eng.pdf
| Other-English Showcards |
|
MP2-Eng.pdf
| Other-English Showcards |
|
MP5-Eng.pdf
| Other-English Showcards |
|
OM3-Eng.pdf
| Other-English Showcards |
|
PA1_PA2_PA4.pdf
| Other-English Showcards |
|
PM1-Eng.pdf
| Other-English Showcards |
|
Ref card for med provider.pdf
| Other-English Showcards |
|
SC1A-Eng.pdf
| Other-English Showcards |
|
SC3-Eng.pdf
| Other-English Showcards |
|
ST1-Eng.pdf
| Other-English Showcards |
|
statement terms glos.pdf
| Other-English Showcards |
|
DI2-Eng.pdf
| Other-English Showcards |
|
DM1-Eng.pdf
| Other-English Showcards |
|
Examples of types of med drs.pdf
| Other-English Showcards |
|
HA1-Eng.pdf
| Other-English Showcards |
|
HF1-Eng.pdf
| Other-English Showcards |
|
HF4-Eng.pdf
| Other-English Showcards |
|
HF7-Eng.pdf
| Other-English Showcards |
|
HH3-Eng.pdf
| Other-English Showcards |
|
HI3 A-D.pdf
| Other-English Showcards |
|
HI3 N.pdf
| Other-English Showcards |
|
HI4-Eng.pdf
| Other-English Showcards |
|
HIMC2-Eng.pdf
| Other-English Showcards |
|
HIT2-Eng.pdf
| Other-English Showcards |
|
IA1-Eng.pdf
| Other-English Showcards |
|
IA4-Eng.pdf
| Other-English Showcards |
|
IU-Eng.pdf
| Other-English Showcards |
|
KN4-Eng.pdf
| Other-English Showcards |
|
Language Identification Card.pdf
| Other-English Showcards |
|
KN9-Eng.pdf
| Other-English Showcards |
|
MP3-Eng.pdf
| Other-English Showcards |
|
OM1-Eng.pdf
| Other-English Showcards |
|
OM4-Eng.pdf
| Other-English Showcards |
|
PD1-Eng.pdf
| Other-English Showcards |
|
pronunc guide.pdf
| Other-English Showcards |
|
RX1-Eng.pdf
| Other-English Showcards |
|
SC1-Eng.pdf
| Other-English Showcards |
|
SC4-Eng.pdf
| Other-English Showcards |
|
ST2-Eng.pdf
| Other-English Showcards |
|
US1-Eng.pdf
| Other-English Showcards |
|
AC_04.01.0001.pdf
| Other-Section By Section |
|
CE_04.01.0000.pdf
| Other-Section By Section |
|
DI_04.01.0002.pdf
| Other-Section By Section |
|
END_04.01.0000.pdf
| Other-Section By Section |
|
EX_03.01.0000.pdf
| Other-Section By Section |
|
HH_05.01.0000.pdf
| Other-Section By Section |
|
HIS_05.01.0000.pdf
| Other-Section By Section |
|
IP_05.01.0000.pdf
| Other-Section By Section |
|
KN_02.01.0003.pdf
| Other-Section By Section |
|
OM_05.01.0000.pdf
| Other-Section By Section |
|
PM_06.01.0001.pdf
| Other-Section By Section |
|
RX_05.01.0000.pdf
| Other-Section By Section |
|
US_05.01.0001.pdf
| Other-Section By Section |
|
AV_05.01.0000.pdf
| Other-Section By Section |
|
CL_07.01.0000.pdf
| Other-Section By Section |
|
DM_05.01.0000.pdf
| Other-Section By Section |
|
ENS_07.01.0001.pdf
| Other-Section By Section |
|
HA_05.01.0003.pdf
| Other-Section By Section |
|
HHS_04.01.0000.pdf
| Other-Section By Section |
|
IA_05.01.0000.pdf
| Other-Section By Section |
|
IRQ_05.01.0000.pdf
| Other-Section By Section |
|
MP_05.01.0000.pdf
| Other-Section By Section |
|
OP_05.01.0000.pdf
| Other-Section By Section |
|
PMS_05.01.0000.pdf
| Other-Section By Section |
|
SC_05.01.0003.pdf
| Other-Section By Section |
|
BackgroundVariables_07.01.0000.pdf
| Other-Section By Section |
|
CPS_07.01.0000.pdf
| Other-Section By Section |
|
DU_04.01.0000.pdf
| Other-Section By Section |
|
ER_04.01.0000.pdf
| Other-Section By Section |
|
HF_05.01.0008.pdf
| Other-Section By Section |
|
HI_05.01.0001.pdf
| Other-Section By Section |
|
IN_05.01.0001.pdf
| Other-Section By Section |
|
IU_05.01.0000.pdf
| Other-Section By Section |
|
NS_07.01.0003.pdf
| Other-Section By Section |
|
PA_04.01.0001.pdf
| Other-Section By Section |
|
PS_04.01.0000.pdf
| Other-Section By Section |
|
ST_05.01.0001.pdf
| Other-Section By Section |
|
ConditionRoster0301_0000PopUpVars.pdf
| Other-Roster |
|
EventRosterBeginDateRV0301_0000PopUpVars.pdf
| Other-Roster |
|
PMRoster04010000PopUpVars.pdf
| Other-Roster |
|
StatementChargeBundleRoster0501_0000PopUpVars.pdf
| Other-Roster |
|
StatementOMEditRoster0301_0000PopUpVars.pdf
| Other-Roster |
|
DMRoster0401_0000PopUpVars.pdf
| Other-Roster |
|
PersonRoster0301_0000PopUpVars.pdf
| Other-Roster |
|
ProviderRoster0301_0000PopUpVars.pdf
| Other-Roster |
|
StatementEventEditRoster0301_0000PopUpVars.pdf
| Other-Roster |
|
EventRosterBeginDate0301_0000PopUpVars.pdf
| Other-Roster |
|
PlanRoster0301_0000PopUpVars.pdf
| Other-Roster |
|
SOPRoster0301_0000PopUpVars.pdf
| Other-Roster |
|
StatementEventRoster0301_0000PopUpVars.pdf
| Other-Roster |
|
ATTACHMENTHI1.pdf
| Other-General Specifications |
|
GeneralSpecifications07010001.pdf
| Other-General Specifications |
|
GeneralSpecificationsDates07010001.pdf
| Other-General Specifications |
|
GeneralSpecificationsQuestionnaireFlow07010001.pdf
| Other-General Specifications |
|
MCBSWVSTechnicalNotes0501_0000.pdf
| Other-General Specifications |
|
ATTACHMENTHI2.pdf
| Other-General Specifications |
|
GeneralSpecificationsAttachments07010001.pdf
| Other-General Specifications |
|
GeneralSpecificationsDefaultSpecification07010001.pdf
| Other-General Specifications |
|
GeneralSpecificationsScreenTypes07010001.pdf
| Other-General Specifications |
|
GeneralSpecificationsDatabase07010001.pdf
| Other-General Specifications |
|
GeneralSpecificationsGlobalDisplays07010001.pdf
| Other-General Specifications |
|
GeneralSpecificationsSectionOverview07010001.pdf
| Other-General Specifications |
|
entire questionnaire condensed.pdf
| Other-Entire Questionnaire Condensed |
|
attachment 01.zip attachment 01 | IC Document |
|
attachment 02.zip attachment 02 | IC Document |
|
attachment 07.zip attachment 07 | IC Document |
|
attachment 08.zip attachment 08 | IC Document |
|
attachment 10.zip attachment 10 | IC Document |
|
Attachment 3 - UPDMCBSBrochure.pdf Attachment 3 - UPDMCBSBrochure | IC Document |
|
Attachment 3 - UPDAttheDoorBrochure2010.pdf Attachment 3 - UPDMCBSBrochure | IC Document |
|
2010AdvanceLetterwithletterhead.pdf 2010AdvanceLetterwithletterhead | IC Document |
|
MCBSConfidentialityAgreement.pdf MCBSConfidentialityAgreement | IC Document |
Information Collection (IC) Details
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