Information Collection

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

IC 8171 under ICR 201702-0938-022 · 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⚠️ Notice: This information collection may be referencing outdated material.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 MCBS Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)	Form and Instruction
Form CMS-P-0015A MCBS Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)	Form and Instruction
Form CMS-P-0015A MCBS Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)	Form and Instruction
Form CMS-P-0015A MCBS Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)	Form and Instruction
Form CMS-P-0015A MCBS Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)	Form and Instruction
Form CMS-P-0015A MCBS Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)	Form and Instruction
Form CMS-P-0015A MCBS Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)	Form and Instruction
Form CMS-P-0015A MCBS Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)	Form and Instruction
Form CMS-P-0015A MCBS Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)	Form and Instruction
Form CMS-P-0015A MCBS Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)	Form and Instruction
Form CMS-P-0015A MCBS Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)	Form and Instruction
Form CMS-P-0015A MCBS Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)	Form and Instruction
Form CMS-P-0015A MCBS Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)	Form and Instruction
Form CMS-P-0015A MCBS Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)	Form and Instruction
Form CMS-P-0015A MCBS Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)	Form and Instruction
Form CMS-P-0015A MCBS Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)	Form and Instruction
Form CMS-P-0015A MCBS Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)	Form and Instruction
Form CMS-P-0015A MCBS Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)	Form and Instruction
Form CMS-P-0015A MCBS Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)	Form and Instruction
Form CMS-P-0015A MCBS Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)	Form and Instruction
Form CMS-P-0015A MCBS Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)	Form and Instruction
Form CMS-P-0015A MCBS Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)	Form and Instruction
Form CMS-P-0015A MCBS Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)	Form and Instruction
Form CMS-P-0015A MCBS Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)	Form and Instruction
Form CMS-P-0015A MCBS Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)	Form and Instruction
Form CMS-P-0015A MCBS Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)	Form and Instruction
Form CMS-P-0015A MCBS Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)	Form and Instruction
Form CMS-P-0015A MCBS Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)	Form and Instruction
Form CMS-P-0015A MCBS Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)	Form and Instruction
Form CMS-P-0015A MCBS Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)	Form and Instruction
Form CMS-P-0015A MCBS Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)	Form and Instruction
Form CMS-P-0015A MCBS Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)	Form and Instruction
Form CMS-P-0015A MCBS Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)	Form and Instruction
Form CMS-P-0015A MCBS Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)	Form and Instruction
Form CMS-P-0015A MCBS Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)	Form and Instruction
Form CMS-P-0015A MCBS Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)	Form and Instruction
Form CMS-P-0015A MCBS Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)	Form and Instruction
Form CMS-P-0015A MCBS Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)	Form and Instruction
Form CMS-P-0015A MCBS Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)	Form and Instruction
Form CMS-P-0015A MCBS Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)	Form and Instruction
Form CMS-P-0015A MCBS Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)	Form and Instruction
Form CMS-P-0015A MCBS Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)	Form and Instruction
Form CMS-P-0015A MCBS Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)	Form and Instruction
Form CMS-P-0015A MCBS Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)	Form and Instruction
Form CMS-P-0015A MCBS Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)	Form and Instruction
Form CMS-P-0015A MCBS Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)	Form and Instruction
Form CMS-P-0015A MCBS Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)	Form and Instruction
Form CMS-P-0015A MCBS Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)	Form and Instruction
Form CMS-P-0015A MCBS Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)	Form and Instruction
Form CMS-P-0015A MCBS Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)	Form and Instruction
Form CMS-P-0015A MCBS Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)	Form and Instruction
Form CMS-P-0015A MCBS Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)	Form and Instruction
Form CMS-P-0015A MCBS Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)	Form and Instruction
Form CMS-P-0015A MCBS Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)	Form and Instruction
Global Displays_06.00.0000.xlsx	Instruction
Medicaid Display List_06.00.0000.xlsx	Instruction
Preload variables for PERS table_06.00.0000.xlsx	Instruction
State Table for help file__06.00.0000.xlsx	Instruction
CMS_P-0015A MCBS AVQ.pdf	Form and Instruction
CMS-P-0015A MCBS CLQ.pdf	Form and Instruction
CMS-P-0015A MCBS CPS.pdf	Form and Instruction
CMS-P-0015A MCBS DIQ.pdf	Form and Instruction
CMS-P-0015A MCBS DUQ.pdf	Form and Instruction
CMS-P-0015A MCBS END.pdf	Form and Instruction
CMS-P-0015A MCBS ENS.pdf	Form and Instruction
CMS-P-0015A MCBS ERQ.pdf	Form and Instruction
CMS-P-0015A MCBS EXQ.pdf	Form and Instruction
CMS-P-0015A MCBS HAQ.pdf	Form and Instruction
CMS-P-0015A MCBS HFQ.pdf	Form and Instruction
CMS-P-0015A MCBS HHQ.pdf	Form and Instruction
CMS-P-0015A MCBS HHS.pdf	Form and Instruction
CMS-P-0015A MCBS HIQ.pdf	Form and Instruction
CMS-P-0015A MCBS HIS.pdf	Form and Instruction
CMS-P-0015A MCBS IAQ.pdf	Form and Instruction
CMS-P-0015A MCBS INQ.pdf	Form and Instruction
CMS-P-0015A MCBS IPQ.pdf	Form and Instruction
CMS-P-0015A MCBS IUQ.pdf	Form and Instruction
CMS-P-0015A MCBS KNQ.pdf	Form and Instruction
CMS-P-0015A MCBS MBQ.pdf	Form and Instruction
CMS-P-0015A MCBS MPQ.pdf	Form and Instruction
CMS-P-0015A MCBS NAQ.pdf	Form and Instruction
CMS-P-0015A MCBS NSQ.pdf	Form and Instruction
CMS-P-0015A MCBS OMQ.pdf	Form and Instruction
CMS-P-0015A MCBS OPQ.pdf	Form and Instruction
CMS-P-0015A MCBS PAQ.pdf	Form and Instruction
CMS-P-0015A MCBS PMQ.pdf	Form and Instruction
CMS-P-0015A MCBS PMS.pdf	Form and Instruction
CMS-P-0015A MCBS PSQ.pdf	Form and Instruction
CMS-P-0015A MCBS PVQ.pdf	Form and Instruction
CMS-P-0015A MCBS R76 Showcards_Combined_08.03.16.pdf	Form and Instruction
CMS-P-0015A MCBS RXQ.pdf	Form and Instruction
CMS-P-0015A MCBS SCQ.pdf	Form and Instruction
CMS-P-0015A MCBS STQ.pdf	Form and Instruction
CMS-P-0015A MCBS USQ.pdf	Form and Instruction
CMS-P-0015A MCBS Attachment 5 Facility Eligibility Screener.pdf	Form and Instruction
CMS-P-0015A MCBS Attachment 6 Facility Showcards.pdf	Form and Instruction
CMS-P-0015A MCBS R69_BQF.docx	Form and Instruction
CMS-P-0015A MCBS R69_BQM.docx	Form and Instruction
CMS-P-0015A MCBS R69_BRF.docx	Form and Instruction
CMS-P-0015A MCBS R69_EXF.docx	Form and Instruction
CMS-P-0015A MCBS R69_FQF.docx	Form and Instruction
CMS-P-0015A MCBS R69_FQM.docx	Form and Instruction
CMS-P-0015A MCBS R69_HSF.docx	Form and Instruction
CMS-P-0015A MCBS R69_INF.docx	Form and Instruction
CMS-P-0015A MCBS R69_IRF.docx	Form and Instruction
CMS-P-0015A MCBS R69_NVF.docx	Form and Instruction
CMS-P-0015A MCBS R69_PMF.docx	Form and Instruction
CMS-P-0015A MCBS R69_PRF.docx	Form and Instruction
CMS-P-0015A MCBS R69_RHF.docx	Form and Instruction
CMS-P-0015A MCBS R69_RHM.docx	Form and Instruction
CMS-P-0015A MCBS R69_SRF.docx	Form and Instruction
CMS-P-0015A MCBS R69_USF.docx	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

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

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS_P-0015A	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-P-0015A	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-P-0015A	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-P-0015A	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-P-0015A	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-P-0015A	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-P-0015A	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-P-0015A	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-P-0015A	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-P-0015A	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-P-0015A	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-P-0015A	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-P-0015A	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-P-0015A	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-P-0015A	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-P-0015A	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-P-0015A	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-P-0015A	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-P-0015A	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-P-0015A	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-P-0015A	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-P-0015A	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-P-0015A	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-P-0015A	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-P-0015A	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-P-0015A	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-P-0015A	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-P-0015A	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-P-0015A	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-P-0015A	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-P-0015A	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-P-0015A	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-P-0015A	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-P-0015A	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-P-0015A	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-P-0015A	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-P-0015A	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-P-0015A	Yes	Yes	Fillable Fileable
Instruction		Yes	Yes	Fillable Fileable
Instruction		Yes	Yes	Fillable Fileable
Instruction		Yes	Yes	Fillable Fileable
Form and Instruction	CMS-P-0015A	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-P-0015A	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-P-0015A	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-P-0015A	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-P-0015A	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-P-0015A	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-P-0015A	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-P-0015A	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-P-0015A	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-P-0015A	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-P-0015A	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-P-0015A	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-P-0015A	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-P-0015A	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-P-0015A	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-P-0015A	Yes	Yes	Fillable Fileable
Instruction		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 16,550

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	49,650	49,650
Annual IC Time Burden (Hours)	60,103	60,103
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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