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

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

OMB: 0938-0568

IC ID: 8171

Documents and Forms
Document Name
Document Type
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Information Collection (IC) Details

View Information Collection (IC)

Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL 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 HFQ - Health Status and Functioning 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

Health Health Care Services

 

35,015 0
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 35,015 0 0 0 0 35,015
Annual IC Time Burden (Hours) 34,368 0 0 0 0 34,368
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.

© 2024 OMB.report | Privacy Policy