Information Collection

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

IC 8171 under ICR 201506-0938-011 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form CMS-P-0015A Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)	Form and Instruction
CMS-P-0015A Attachment 5 - Facility Screener Facility Screener May 2012.pdf	Form and Instruction
CMS-P0015A Attachment 6 - MCBS Faclility Round 64 Instruments attachment 6.zip	Form and Instruction
CMS-P0015A Attachment 8 - Verification Re-interview ValidationInterviewCommunityComponent.zip	Form and Instruction
CMS-P0015A MCBS Household Round 67 Instruments Attachment 4.zip	Form and Instruction
CMS-P0015A General Specifications Screen Types_19.01.0001 General Specifications Screen Types_19.01.0001.pdf	Form and Instruction
CMS-P0015A General Specifications Spanish Text_19.01.001 General Specifications Spanish Text_19.01.001.pdf	Form and Instruction
CMS-P0015A Spanish Folder General Specifications Spanish Text_19.01 General Specifications Spanish Text_19.01.001.pdf	Form and Instruction
CMS-P0015A English Showcards HI-Eng HI-Eng.pdf	Form and Instruction
CMS-P0015A Spanish Showcars KN-Sp KN-Sp.pdf	Form and Instruction
CMS-P0015A English Section by Section CPS_16.01.0002 CPS_16.01.0002.pdf	Form and Instruction
CMS-P0015A English Section by Section ENS_10.01.0001 ENS_10.01.0001.pdf	Form and Instruction
CMS-P0015A English Section by Section HF_10.01.0002 HF_10.01.0002.pdf	Form and Instruction
CMS-P0015A English Section by Section HI_17.01.0002 HI_17.01.0002.pdf	Form and Instruction
CMS-P0015A English Section by Section HIS_13.01.0001 HIS_13.01.0001.pdf	Form and Instruction
CMS-P0015A English Section by Section IA_08.01.0000 IA_08.01.0000.pdf	Form and Instruction
CMS-P0015A English Section by Section IN_12.01.0000 IN_12.01.0000.pdf	Form and Instruction
CMS-P0015A English Section by Section KN_05.01.0002 KN_05.01.0002.pdf	Form and Instruction
CMS-P0015A English Section by Section NS_18.01.0000.pdf	Form and Instruction
CMS-P0015A English Section by Section OM_09.01.0000.pdf	Form and Instruction
CMS-P0015A English Section by Section PM_14.01.0001.pdf	Form and Instruction
CMS-P0015A English Section by Section RX_07.01.0000.pdf	Form and Instruction
CMS-P0015A English Section by Section SC_09.01.0000.pdf	Form and Instruction
CMS-P0015A English Section by Section ST_15.01.0001.pdf	Form and Instruction
CMS-P0015A MCBS Round 73 Questionnaires Round 73 Questionnaires.pdf	Form and Instruction
Attachments TOC.pdf Table of Contents	IC Document
attachment 2.zip Attachment 2 - Publications	IC Document
Attachment 3.zip Attachment 3 - Letter, Brochure, Agreement	IC Document
attachment07.pdf Attachment 7 - Consent Forms	IC Document
attachment09.pdf Attachment 9 - Impact of Nonsresponse on MCBS Estimates	IC Document
attachment10.pdf Attachment 10 - Primary Sampling Unit Breakdown	IC Document

Information Collection (IC) Details

Record metadata
IC Title	Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)