Information Collection

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

IC 8171 under ICR 202306-0938-009 · 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⚠️ Notice: This information collection may be referencing outdated material.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
CMS-P-0015A Cost Payment Summary 2023_Cost_Payment_Summary_CPS.pdf	Form
CMS-P-0015A Cost Payment Summary 2023_Cost_Payment_Summary_CPS.pdf	Form
CMS-P-0015A Demographic Income 2023_Demographics_Income_DIQ.pdf	Form
CMS-P-0015A Demographic Income 2023_Demographics_Income_DIQ.pdf	Form
CMS-P-0015A End Questionaire 2023_End_END.pdf	Form
CMS-P-0015A End Questionaire 2023_End_END.pdf	Form
CMS-P-0015A Enumeration Summary 2022_Enumeration_Summary_ENS.pdf	Form
CMS-P-0015A Enumeration Summary 2022_Enumeration_Summary_ENS.pdf	Form
CMS-P-0015A Mobility of Beneficiaries 2022_Mobility_MBQ.pdf	Form
CMS-P-0015A Mobility of Beneficiaries 2022_Mobility_MBQ.pdf	Form
CMS-P-0015A Post Statement Cost 2022_Post_Statement_Cost_PSQ.pdf	Form
CMS-P-0015A Post Statement Cost 2022_Post_Statement_Cost_PSQ.pdf	Form
CMS-P-0015A Access to Care 2022_Access_to_Care_ACQ.pdf	Form
CMS-P-0015A Access to Care 2022_Access_to_Care_ACQ.pdf	Form
CMS-P-0015A Chronic Pain 2023_Chronic_Pain_CPQ.pdf	Form
CMS-P-0015A Chronic Pain 2024_Chronic_Pain_CPQ.pdf	Form
CMS-P-0015A Dental, Vision, and Hearing Care Utilization 2023_Den_Vis_Hear_Care_Utl_DVH.pdf	Form
CMS-P-0015A Dental, Vision, and Hearing Care Utilization 2023_Den_Vis_Hear_Care_Utl_DVH.pdf	Form
CMS-P-0015A Drug Coverage 2022_Drug_Coverage_RXQ.pdf	Form
CMS-P-0015A Drug Coverage 2022_Drug_Coverage_RXQ.pdf	Form
CMS-P-0015A Emergency Utilization 2022_Emergency_Utilization_ERQ.pdf	Form
CMS-P-0015A Emergency Utilization 2022_Emergency_Utilization_ERQ.pdf	Form
CMS-P-0015A Health Insurance 2024_Health_Insurance_HIQ.pdf	Form
CMS-P-0015A Health Insurance 2024_Health_Insurance_HIQ.pdf	Form
CMS-P-0015A Home Health 2022_Home_Health_Util_HHQ.pdf	Form
CMS-P-0015A Home Health 2022_Home_Health_Util_HHQ.pdf	Form
CMS-P-0015A Housing_Characteristics 2022_Housing_Charcs_HAQ.pdf	Form
CMS-P-0015A Housing_Characteristics 2022_Housing_Charcs_HAQ.pdf	Form
CMS-P-0015A Income_and_ Assets 2022_Income_and_Assets_IAQ.pdf	Form
CMS-P-0015A Income_and_ Assets 2022_Income_and_Assets_IAQ.pdf	Form
CMS-P-0015A Inpatient Utilization 2022_Inpatient_Utilization_IPQ.pdf	Form
CMS-P-0015A Inpatient Utilization 2022_Inpatient_Utilization_IPQ.pdf	Form
CMS-P-0015A Institutional Utilization 2022_Institutional_Util_IUQ.pdf	Form
CMS-P-0015A Institutional Utilization 2022_Institutional_Util_IUQ.pdf	Form
CMS-P-0015A Introduction 2023_Introduction_INQ.pdf	Form
CMS-P-0015A Introduction 2023_Introduction_INQ.pdf	Form
CMS-P-0015A Medical Provider Utilzation 2022_Medical_Provider_Util_MPQ.pdf	Form
CMS-P-0015A Medical Provider Utilzation 2022_Medical_Provider_Util_MPQ.pdf	Form
CMS-P-0015A Nicotine Alcohol 2022_Nicotine_Alcohol_Use_NAQ.pdf	Form
CMS-P-0015A Nicotine Alcohol 2022_Nicotine_Alcohol_Use_NAQ.pdf	Form
CMS-P-0015A No Statement Cost 2023_No_Statement_Cost_NSQ.pdf	Form
CMS-P-0015A No Statement Cost 2023_No_Statement_Cost_NSQ.pdf	Form
CMS-P-0015A Other Medical Expense 2022_Other_Medical_Expense_OMQ.pdf	Form
CMS-P-0015A Other Medical Expense 2022_Other_Medical_Expense_OMQ.pdf	Form
CMS-P-0015A Outpatient Utilization 2022_Outpatient_Util_OPQ.pdf	Form
CMS-P-0015A Outpatient Utilization 2022_Outpatient_Util_OPQ.pdf	Form
CMS-P-0015A Prescribed Medicine Utilization 2022_Prescribed_Med_Util_PMQ.pdf	Form
CMS-P-0015A Prescribed Medicine Utilization 2022_Prescribed_Med_Util_PMQ.pdf	Form
CMS-P-0015A Satisfaction Care 2023_Satisfaction_with_Care_SCQ.pdf	Form
CMS-P-0015A Satisfaction Care 2023_Satisfaction_with_Care_SCQ.pdf	Form
CMS-P-0015A Statement Cost Series 2023_Statement_Cost_Series_STQ.pdf	Form
CMS-P-0015A Statement Cost Series 2023_Statement_Cost_Series_STQ.pdf	Form
CMS-P-0015A Beneficiary Knowledge 2023_Beneficiary_Knowledge_KNQ.pdf	Form
CMS-P-0015A Beneficiary Knowledge 2023_Beneficiary_Knowledge_KNQ.pdf	Form
CMS-P-0015A Preventive Care 2023_Preventive_Care_PVQ.pdf	Form
CMS-P-0015A Preventive Care 2023_Preventive_Care_PVQ.pdf	Form
CMS-P-0015A Usual Source of Care 2024_Usual_Source_Of_Care_USQ.pdf	Form
CMS-P-0015A Usual Source of Care 2024_Usual_Source_Of_Care_USQ.pdf	Form
CMS-P-0015A Showcards and Reference Cards 2024CommShowcards508.pdf	Form
CMS-P-0015A Showcards and Reference Cards 2024CommShowcards508.pdf	Form
CMS-P-0015A Facility Showcards 2023FacilityShowcards.pdf	Form
CMS-P-0015A Facility Showcards 2023FacilityShowcards.pdf	Form
CMS-P-0015A Facility Screener Fac2022_Facility_Screener_FACSCREEN.pdf	Form
CMS-P-0015A Facility Screener Fac2022_Facility_Screener_FACSCREEN.pdf	Form
CMS-P-0015A Residence History Missing Data Fac2022_Residence_Missing_RHM.pdf	Form
CMS-P-0015A Residence History Missing Data Fac2022_Residence_Missing_RHM.pdf	Form
CMS-P-0015A Residence History Fac2022_Residence_History_RH.pdf	Form
CMS-P-0015A Residence History Fac2022_Residence_History_RH.pdf	Form
CMS-P-0015A Use of Health Services Fac2023_Health_Status_HS.pdf	Form
CMS-P-0015A Use of Health Services Fac2023_Health_Status_HS.pdf	Form
CMS-P-0015A Background_Questionnaire Fac2023_Background_BQ.pdf	Form
CMS-P-0015A Background_Questionnaire Fac2023_Background_BQ.pdf	Form
CMS-P-0015A Background_Questionnaire MIssing Data Fac2022_Background_Missing_BQM.pdf	Form
CMS-P-0015A Background_Questionnaire MIssing Data Fac2022_Background_Missing_BQM.pdf	Form
CMS-P-0015A Expenditures Fac2022_Expenditures_EX.pdf	Form
CMS-P-0015A Expenditures Fac2022_Expenditures_EX.pdf	Form
CMS-P-0015A Questionaire Missing Data Fac2022_Facility_Missing_FQM.pdf	Form
CMS-P-0015A Questionaire Missing Data Fac2022_Facility_Missing_FQM.pdf	Form
CMS-P-0015A Questionaire Fac2022_Facility_Quex_FQ.pdf	Form
CMS-P-0015A Questionaire Fac2022_Facility_Quex_FQ.pdf	Form
CMS-P-0015A Health_Insurance Fac2023_Health_Insurance_IN.pdf	Form
CMS-P-0015A Health_Insurance Fac2023_Health_Insurance_IN.pdf	Form
CMS-P-0015A Health_Status Fac2023_Health_Status_HS.pdf	Form
CMS-P-0015A Health_Status Fac2023_Health_Status_HS.pdf	Form
CMS-P-0015A Cognitive Measures 2023_Cognitive_Measures_CMQ.pdf	Form
CMS-P-0015A Cognitive Measures 2023_Cognitive_Measures_CMQ.pdf	Form
CMS-P-0015A Health Status and Functioning Questionnaire Specificatio 2024_Health_Status_HFQ.pdf	Form
CMS-P-0015A Health Status and Functioning Questionnaire Specificatio 2024_Health_Status_HFQ.pdf	Form
CMS-P-0015A Physical_Measures 2023_Physical_Measures_PXQ.pdf	Form
CMS-P-0015A Physical_Measures 2023_Physical_Measures_PXQ.pdf	Form
P-0015A COVID-19 Questionnaire Specifications Fac2024_COVID_19_Bene_CV.pdf	Form
P-0015A COVID-19 Questionnaire Specifications Fac2024_COVID_19_Bene_CV.pdf	Form
P-0015A COVID-19 Facility-Level Supplement 2024_COVID_19_CVQ.pdf	Form
P-0015A COVID-19 Facility-Level Supplement 2024_COVID_19_CVQ.pdf	Form
CMS-P-0015A Use of Health Services Section Specifications Fac2023_Use_Health_Services_US.pdf	Form
CMS-P-0015A Use of Health Services Section Specifications Fac2023_Use_Health_Services_US.pdf	Form
CMS-P-0015A Telemedicine Questionnaire 2023_Telemedicine_TLQ.pdf	Form
CMS-P-0015A Telemedicine Questionnaire 2023_Telemedicine_TLQ.pdf	Form
CMS-P-0015A Physical Measures Frequently Asked Questions (FAQ) Sheet ComPhysicalMeasuresFAQ.pdf	Form
CMS-P-0015A Physical Measures Frequently Asked Questions (FAQ) Sheet ComPhysicalMeasuresFAQ.pdf	Form

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: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-P-0015A	Cost Payment Summary	2023_Cost_Payment_Summary_CPS.pdf	Yes	Yes	Fillable Fileable
Form	CMS-P-0015A	Demographic Income	2023_Demographics_Income_DIQ.pdf	Yes	Yes	Fillable Fileable
Form	CMS-P-0015A	End Questionaire	2023_End_END.pdf	Yes	Yes	Fillable Fileable
Form	CMS-P-0015A	Enumeration Summary	2022_Enumeration_Summary_ENS.pdf	Yes	Yes	Fillable Fileable
Form	CMS-P-0015A	Mobility of Beneficiaries	2022_Mobility_MBQ.pdf	Yes	Yes	Fillable Fileable
Form	CMS-P-0015A	Post Statement Cost	2022_Post_Statement_Cost_PSQ.pdf	Yes	Yes	Fillable Fileable
Form	CMS-P-0015A	Access to Care	2022_Access_to_Care_ACQ.pdf	Yes	Yes	Fillable Fileable
Form	CMS-P-0015A	Chronic Pain	2024_Chronic_Pain_CPQ.pdf	Yes	Yes	Fillable Fileable
Form	CMS-P-0015A	Dental, Vision, and Hearing Care Utilization	2023_Den_Vis_Hear_Care_Utl_DVH.pdf	Yes	Yes	Fillable Fileable
Form	CMS-P-0015A	Drug Coverage	2022_Drug_Coverage_RXQ.pdf	Yes	Yes	Fillable Fileable
Form	CMS-P-0015A	Emergency Utilization	2022_Emergency_Utilization_ERQ.pdf	Yes	Yes	Fillable Fileable
Form	CMS-P-0015A	Health Insurance	2024_Health_Insurance_HIQ.pdf	Yes	Yes	Fillable Fileable
Form	CMS-P-0015A	Home Health	2022_Home_Health_Util_HHQ.pdf	Yes	Yes	Fillable Fileable
Form	CMS-P-0015A	Housing_Characteristics	2022_Housing_Charcs_HAQ.pdf	Yes	Yes	Fillable Fileable
Form	CMS-P-0015A	Income_and_ Assets	2022_Income_and_Assets_IAQ.pdf	Yes	Yes	Fillable Fileable
Form	CMS-P-0015A	Inpatient Utilization	2022_Inpatient_Utilization_IPQ.pdf	Yes	Yes	Fillable Fileable
Form	CMS-P-0015A	Institutional Utilization	2022_Institutional_Util_IUQ.pdf	Yes	Yes	Fillable Fileable
Form	CMS-P-0015A	Introduction	2023_Introduction_INQ.pdf	Yes	Yes	Fillable Fileable
Form	CMS-P-0015A	Medical Provider Utilzation	2022_Medical_Provider_Util_MPQ.pdf	Yes	Yes	Fillable Fileable
Form	CMS-P-0015A	Nicotine Alcohol	2022_Nicotine_Alcohol_Use_NAQ.pdf	Yes	Yes	Fillable Fileable
Form	CMS-P-0015A	No Statement Cost	2023_No_Statement_Cost_NSQ.pdf	Yes	Yes	Fillable Fileable
Form	CMS-P-0015A	Other Medical Expense	2022_Other_Medical_Expense_OMQ.pdf	Yes	Yes	Fillable Fileable
Form	CMS-P-0015A	Outpatient Utilization	2022_Outpatient_Util_OPQ.pdf	Yes	Yes	Fillable Fileable
Form	CMS-P-0015A	Prescribed Medicine Utilization	2022_Prescribed_Med_Util_PMQ.pdf	Yes	Yes	Fillable Fileable
Form	CMS-P-0015A	Satisfaction Care	2023_Satisfaction_with_Care_SCQ.pdf	Yes	Yes	Fillable Fileable
Form	CMS-P-0015A	Statement Cost Series	2023_Statement_Cost_Series_STQ.pdf	Yes	Yes	Fillable Fileable
Form	CMS-P-0015A	Beneficiary Knowledge	2023_Beneficiary_Knowledge_KNQ.pdf	Yes	Yes	Fillable Fileable
Form	CMS-P-0015A	Preventive Care	2023_Preventive_Care_PVQ.pdf	Yes	Yes	Fillable Fileable
Form	CMS-P-0015A	Usual Source of Care	2024_Usual_Source_Of_Care_USQ.pdf	Yes	Yes	Fillable Fileable
Form	CMS-P-0015A	Showcards and Reference Cards	2024CommShowcards508.pdf	Yes	Yes	Fillable Fileable
Form	CMS-P-0015A	Facility Showcards	2023FacilityShowcards.pdf	Yes	Yes	Fillable Fileable
Form	CMS-P-0015A	Facility Screener	Fac2022_Facility_Screener_FACSCREEN.pdf	Yes	Yes	Fillable Fileable
Form	CMS-P-0015A	Residence History Missing Data	Fac2022_Residence_Missing_RHM.pdf	Yes	Yes	Fillable Fileable
Form	CMS-P-0015A	Residence History	Fac2022_Residence_History_RH.pdf	Yes	Yes	Fillable Fileable
Form	CMS-P-0015A	Use of Health Services	Fac2023_Health_Status_HS.pdf	Yes	Yes	Fillable Fileable
Form	CMS-P-0015A	Background_Questionnaire	Fac2023_Background_BQ.pdf	Yes	Yes	Fillable Fileable
Form	CMS-P-0015A	Background_Questionnaire MIssing Data	Fac2022_Background_Missing_BQM.pdf	Yes	Yes	Fillable Fileable
Form	CMS-P-0015A	Expenditures	Fac2022_Expenditures_EX.pdf	Yes	Yes	Fillable Fileable
Form	CMS-P-0015A	Questionaire Missing Data	Fac2022_Facility_Missing_FQM.pdf	Yes	Yes	Fillable Fileable
Form	CMS-P-0015A	Questionaire	Fac2022_Facility_Quex_FQ.pdf	Yes	Yes	Fillable Fileable
Form	CMS-P-0015A	Health_Insurance	Fac2023_Health_Insurance_IN.pdf	Yes	Yes	Fillable Fileable
Form	CMS-P-0015A	Health_Status	Fac2023_Health_Status_HS.pdf	Yes	Yes	Fillable Fileable
Form	CMS-P-0015A	Cognitive Measures	2023_Cognitive_Measures_CMQ.pdf	Yes	Yes	Fillable Fileable
Form	CMS-P-0015A	Health Status and Functioning Questionnaire Specification	2024_Health_Status_HFQ.pdf	Yes	Yes	Fillable Fileable
Form	CMS-P-0015A	Physical_Measures	2023_Physical_Measures_PXQ.pdf	Yes	Yes	Fillable Fileable
Form	P-0015A	COVID-19 Questionnaire Specifications	Fac2024_COVID_19_Bene_CV.pdf	Yes	Yes	Fillable Fileable
Form	P-0015A	COVID-19 Facility-Level Supplement	2024_COVID_19_CVQ.pdf	Yes	Yes	Fillable Fileable
Form	CMS-P-0015A	Use of Health Services Section Specifications	Fac2023_Use_Health_Services_US.pdf	Yes	Yes	Fillable Fileable
Form	CMS-P-0015A	Telemedicine Questionnaire	2023_Telemedicine_TLQ.pdf	Yes	Yes	Fillable Fileable
Form	CMS-P-0015A	Physical Measures Frequently Asked Questions (FAQ) Sheet	ComPhysicalMeasuresFAQ.pdf	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: 35,015

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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	35,015	-983	35,998
Annual IC Time Burden (Hours)	34,368	-12,145	46,513
Annual IC Cost Burden (Dollars)	0	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.