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

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-P-0015A Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)	Form	Modified	Missing upstream
CMS-P-0015A 0938-0568_SSA.docx	Supporting Statement A	Uploaded 2024-07-24	Repair queued
NonResponseLetterFraud.pdf	Supplementary Document	Uploaded 2024-07-11	Repair queued
Responses to Public Comments.docx	Supplementary Document	Uploaded 2024-07-11	Missing upstream
2025 Full Clearance 30-Day Crosswalk of Statements.docx	Supplementary Document	Uploaded 2024-07-11	Repair queued
CMS-P-0015A_0938-0568_SSB.docx	Supporting Statement B	Uploaded 2024-07-11	Repair queued
Fall 2023 Expanded Outreach Efforts.docx	Supplementary Document	Uploaded 2023-09-11	Repair queued
Attachment 8. 2024 Testing Report.pdf	Supplementary Document	Uploaded 2023-06-26	Repair queued
RedesignedComBrochure.pdf	Supplementary Document	Uploaded 2022-03-29	Repair queued
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	Repair queued
ComLanguageInsert.pdf	Supplementary Document	Uploaded 2023-06-26	Repair queued
BaseThankYouLetter.pdf	Supplementary Document	Uploaded 2023-06-26	Repair queued
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	Repair queued
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	Repair queued
NonResponseLetter.pdf	Supplementary Document	Uploaded 2023-06-26	Repair queued
IncomeandAssetsBrochure.pdf	Supplementary Document	Uploaded 2024-07-11	Repair queued
RedesignedComBrochure.pdf	Supplementary Document	Uploaded 2023-06-26	Repair queued
MCBSCommunityBrochure.pdf	Supplementary Document	Uploaded 2023-06-26	Available
CommunityAuthLetter.pdf	Supplementary Document	Uploaded 2023-06-26	Repair queued
ComAdvLetterContactYou.pdf	Supplementary Document	Uploaded 2023-06-26	Missing upstream
MCBS Facility Brochure.pdf	Supplementary Document	Uploaded 2024-07-11	Missing upstream
FacAdvanceLetter.pdf	Supplementary Document	Uploaded 2024-07-11	Repair queued
Attachment 6. CAPI screenshots.pdf	Supplementary Document	Uploaded 2024-07-11	Repair queued
NextofKinForm.pdf	Supplementary Document	Uploaded 2024-07-11	Repair queued
ResConsentForm.pdf	Supplementary Document	Uploaded 2024-07-11	Repair queued
HIPAALetter.pdf	Supplementary Document	Uploaded 2024-07-11	Repair queued
AtDoorSheet.pdf	Supplementary Document	Uploaded 2024-07-11	Repair queued
MCBSCalendar.pdf	Supplementary Document	Uploaded 2024-07-11	Available
MCBSRespondentNewsletter.pdf	Supplementary Document	Uploaded 2023-06-26	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
8171	Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)	Form	Modified

ICR Details

OMB Control No: 0938-0568	ICR Reference No: 202407-0938-007
Status: Received in OIRA	Previous ICR Reference No: 202404-0938-001
Agency/Subagency: HHS/CMS	Agency Tracking No: OEDA
Title: Medicare Current Beneficiary Survey (MCBS) (CMS-P-0015A)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 07/24/2024

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	08/31/2025
Responses	35,015	35,015
Time Burden (Hours)	35,344	34,368
Cost Burden (Dollars)	0	0

---

Abstract: The Medicare Current Beneficiary Survey (MCBS) is a continuous, multipurpose survey of a nationally representative sample of aged, disabled, and institutionalized Medicare beneficiaries. MCBS, which is sponsored by the Centers for Medicare & Medicaid Services (CMS), is the only comprehensive source of information on the health status, health care use and expenditures, health insurance coverage, and socioeconomic and demographic characteristics of the entire spectrum of Medicare beneficiaries. The purpose of this revision is to seek approval for CMS to add new items related to beneficiary-centric provisions of the Inflation Reduction Act (IRA) of 2022 to the MCBS Community Questionnaire beginning in 2025 . The new items cover improved measures, streamlined content, and the addition of important IRA-related topics as requested by OMB in their terms of clearance specified in the approval of the 2024 MCBS.

---

Authorizing Statute(s): PL: Pub.L. 108 - 173 723 Name of Law: Medicare Prescription Drug, Improvement, and Modernization Act
   PL: Pub.L. 111 - 148 3021 Name of Law: Affordable Care Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 32435	04/26/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 57901	07/16/2024
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)	CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, P-0015A, P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A	Cost Payment Summary ,   Demographic Income ,   End Questionaire ,   Enumeration Summary ,   Mobility of Beneficiaries ,   Post Statement Cost ,   Access to Care ,   Chronic Pain ,   Dental, Vision, and Hearing Care Utilization ,   Drug Coverage ,   Emergency Utilization ,   Health Insurance ,   Home Health ,   Housing_Characteristics ,   Income_and_ Assets ,   Inpatient Utilization ,   Institutional Utilization ,   Introduction ,   Medical Provider Utilzation ,   Nicotine Alcohol ,   No Statement Cost ,   Other Medical Expense ,   Outpatient Utilization ,   Prescribed Medicine Utilization ,   Satisfaction Care ,   Statement Cost Series ,   Beneficiary Knowledge ,   Preventive Care ,   Usual Source of Care ,   Showcards and Reference Cards ,   Facility Showcards ,   Facility Screener ,   Residence History Missing Data ,   Residence History ,   Use of Health Services ,   Background_Questionnaire ,   Background_Questionnaire MIssing Data ,   Expenditures ,   Questionaire Missing Data ,   Questionaire ,   Health_Insurance ,   Health_Status ,   Cognitive Measures ,   HFQ - Health Status and Functioning ,   Physical_Measures ,   COVID-19 Questionnaire Specifications ,   COVID-19 Facility-Level Supplement ,   Use of Health Services Section Specifications ,   Telemedicine Questionnaire ,   Physical Measures Frequently Asked Questions (FAQ) Sheet ,   Immunization ,   Health_Status ,   Interviewer_Remarks

---

ICR Summary of Burden

table that charts list of burden

	Total Request	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	35,015	35,015	0	0	0	0
Annual Time Burden (Hours)	35,344	34,368	0	976	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The revisions include the addition of 52 items, the migration of four existing items, and the deletion of 26 items that result in a net burden increase of 6.4 minutes. As a result, the total burden has increased to 35,344 from the previously approved total burden of 34,368. This is a net increase of 976 burden hours annually.

---

Annual Cost to Federal Government: $24,400,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Yes

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 07/24/2024

---