CAPI Screenshots of Introductory Screen and Thank You Screen

Attachment 6. CAPI screenshots.pdf

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

CAPI Screenshots of Introductory Screen and Thank You Screen

OMB: 0938-0568

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0938-0568 can be found here:

2024-04-01 - No material or nonsubstantive change to a currently approved collection

Document [pdf]

Download: pdf | pdf

NORC

| Attachment 6 CAPI Screenshots

Community Questionnaire Introduction Screen

PAGE | 1

NORC

| Attachment 6 CAPI Screenshots

Community Questionnaire End Screen

PAGE | 2

NORC

| Attachment 6 CAPI Screenshots

Community Questionnaire End Screen for Baseline Beneficiaries

PAGE | 3

NORC

| Attachment 6 CAPI Screenshots

Facility Instrument Screenshot

PAGE | 4

NORC

| Attachment 6 CAPI Screenshots

Facility Screener Screenshot

PAGE | 5

File Type	application/pdf
File Title	CAPIScreenshots
Subject	MCBS, Community, Facility, Questionnaire, English
Author	NORC
File Modified	2022-12-22
File Created	2022-12-22