Table of Contents

Medicare Current Beneficiary Survey

Attachments

Attachment 1:

Federal Register Notice

Attachment 2:

Publications

Attachment 3:

Advance Letter
MCBS Brochure and Introduction to MCBS Sheet
Confidentially Agreement

Attachment 4:

MCBS Household Round 67 Instruments to Include:
A) Questionnaire Layout
B) English
1) Entire Questionnaire in Condensed Format
2) Entire Questionnaire in Comprehensive Format
a) Section by Section
b) General Specifications
c) Rosters
3) Show Cards
C) Spanish
1) Questionnaire
2) Show Cards

Attachment 5:

Facility Screening Interview Script for Meeting with Facility Administrators
(Included is the Facility Questionnaire Layout)

Attachment 6:

MCBS Facility Round 64 Instruments to Include:
A) Facility Questionnaire Layout
B) Section by Section Questionnaire

Attachment 7:

Consent Forms: Resident and Next of Kin Authorization to Obtain Information
from Medical Records

Attachment 8:

Verification Re-interview

Attachment 9:

“Impact of Nonresponse on Medicare Current Beneficiary Survey Estimates”

Attachment 10: Primary Sampling Unit Breakdown: State, County and City