Invitation & Screening

Medicare Part C and Medicare Part D Enrollment Form Interviews (CMS-10816)

OMB: 0938-1440

IC ID: 257116

Documents and Forms

Document Name Document Type
Form CMS-10816 Invitation & Screening Form and Instruction
CMS-10816 Recruitment Script Attachment A - Recruitment Script CMS-10816_508.pdf Form and Instruction
CMS-10816 Eligibility Screener Questionnaire Attachment C - Eligibility Screener Questionnaire_Clean.docx Form and Instruction
Attachment B - Medicare Part C D Enrollment Form Study Frequently Asked Questions CMS-10816_508.pdf Frequently Asked Questions IC Document