Information Collection Request
Medicare Current Beneficiary Survey (MCBS) (CMS-P-0015A)
ICR 202306-0938-009 · OMB 0938-0568 · Received in OIRA
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-0568 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form CMS-P-0015A Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A) |
Form | Modified | Repair queued |
 Attachment 8. 2024 Testing Report.pdf |
Supplementary Document | Uploaded 2023-06-26 | Repair queued |
| MCBS 2024 Summary of Item-Level Changes_06052023.pdf |
Supplementary Document | Uploaded 2023-06-26 | Missing upstream |
 CMS-P-0015A 0938-0568_SSA.docx |
Supporting Statement A | Uploaded 2023-06-26 | Repair queued |
| 2024 Full Clearance 30-Day Crosswalk.docx |
Supplementary Document | Uploaded 2023-06-26 | Repair queued |
| CMS-P-0015A_0938-0568_SSB.docx |
Supporting Statement B | Uploaded 2023-06-26 | Repair queued |
| Responses to Public Comments_60day.docx |
Supplementary Document | Uploaded 2023-06-26 | Repair queued |
| RedesignedComBrochure.pdf |
Supplementary Document | Uploaded 2022-03-29 | Missing upstream |
| HCStatementGPLetter.pdf |
Supplementary Document | Uploaded 2023-06-26 | Repair queued |
| FacThankYouLetter.pdf |
Supplementary Document | Uploaded 2023-06-26 | Repair queued |
| FacPrepInterviewLetter.pdf |
Supplementary Document | Uploaded 2023-06-26 | Repair queued |
| FacAdvLetterBillOffices.pdf |
Supplementary Document | Uploaded 2023-06-26 | Missing upstream |
| ComLanguageInsert.pdf |
Supplementary Document | Uploaded 2023-06-26 | Repair queued |
| BaseThankYouLetter.pdf |
Supplementary Document | Uploaded 2023-06-26 | Missing upstream |
| BaseFAQEnclosure.pdf |
Supplementary Document | Uploaded 2023-06-26 | Repair queued |
| AdvLetterFAQEnclosure.pdf |
Supplementary Document | Uploaded 2022-03-29 | Repair queued |
| ComAdvLetterCallUs.pdf |
Supplementary Document | Uploaded 2023-06-26 | Missing upstream |
| ComAdvLetterContactYou.pdf |
Supplementary Document | Uploaded 2022-03-29 | Repair queued |
| Attachment 7. 2023 Testing Report.pdf |
Supplementary Document | Uploaded 2023-06-26 | Repair queued |
| CMSThankYouLetter.pdf |
Supplementary Document | Uploaded 2023-06-26 | Repair queued |
| Reminder Postcard_Phone.docx |
Supplementary Document | Uploaded 2020-11-23 | Repair queued |
| ReminderPostcard.pdf |
Supplementary Document | Uploaded 2023-06-26 | Repair queued |
| Reminder Letter_Phone_English.docx |
Supplementary Document | Uploaded 2020-11-23 | Repair queued |
| ReminderLetter.pdf |
Supplementary Document | Uploaded 2023-06-26 | Missing upstream |
| NonResponseLetter.pdf |
Supplementary Document | Uploaded 2023-06-26 | Repair queued |
| IncomeandAssetsBrochure.pdf |
Supplementary Document | Uploaded 2023-06-26 | Repair queued |
| RedesignedComBrochure.pdf |
Supplementary Document | Uploaded 2023-06-26 | Missing upstream |
| MCBSCommunityBrochure.pdf |
Supplementary Document | Uploaded 2023-06-26 | Repair queued |
| CommunityAuthLetter.pdf |
Supplementary Document | Uploaded 2023-06-26 | Repair queued |
| ComAdvLetterContactYou.pdf |
Supplementary Document | Uploaded 2023-06-26 | Repair queued |
| MCBSFacilityBrochure.pdf |
Supplementary Document | Uploaded 2023-06-26 | Repair queued |
| FacAdvanceLetter.pdf |
Supplementary Document | Uploaded 2023-06-26 | Repair queued |
| Attachment 6. CAPI screenshots.pdf |
Supplementary Document | Uploaded 2023-06-26 | Repair queued |
| NextofKinForm.pdf |
Supplementary Document | Uploaded 2023-06-26 | Repair queued |
| ResConsentForm.pdf |
Supplementary Document | Uploaded 2023-06-26 | Repair queued |
| HIPAALetter.pdf |
Supplementary Document | Uploaded 2023-06-26 | Repair queued |
| AtDoorSheet.pdf |
Supplementary Document | Uploaded 2023-06-26 | Repair queued |
| MCBSCalendar.pdf |
Supplementary Document | Uploaded 2023-06-26 | Repair queued |
| MCBSRespondentNewsletter.pdf |
Supplementary Document | Uploaded 2023-06-26 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 8171 |  Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A) |
Form | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/CMS |
| OMB Control No | 0938-0568 |
| Type of Information Collection | Revision of a currently approved collection |
| Previous ICR Reference No | 202203-0938-013 |
| Agency Tracking No | OEDA |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |