Community Advance Letter Multimode

[Mailing ID]
[Respondent Name]
[Respondent Address]
[Respondent City, State Zip]

[Month, Year]

Dear [Respondent Name]:
Within the next few weeks, a representative of our agency will contact you to ask permission to
interview you about your experiences receiving Medicare services. The representative will ask to talk
with you for about an hour during a time that would be convenient.
The Centers for Medicare & Medicaid Services is conducting this study to better understand the
experiences of people with Medicare. The best way to gather this information is by hearing directly
from people with Medicare.
We have selected you as part of a sample of people with Medicare from across the United States that
can give us an accurate picture of how well people’s health care needs are being met.
Your participation in the study is your choice. Your Medicare benefits cannot be affected in any way
by your decision to participate or the answers you provide, and your information will be kept private
to the extent permitted by law, as prescribed by the Federal Privacy Act of 1974.
The representative who will contact you is from NORC at the University of Chicago, the research
institution collecting this information for us. If we are unable to reach you by phone, our
representative may visit you in-person to conduct the interview. This person will have identification
showing they are a representative for this Medicare survey.
If you are unable for any reason to participate in the interview, a friend or relative can also complete
the interview on your behalf.
If you have any questions, please call NORC toll-free at 1-844-777-2151, or email [email protected]. If
it would be more convenient for you to set up an appointment for your interview, please call or email
us. The enclosed material has more information about why we are conducting this study. You can
also visit the study website at mcbs.norc.org.
I hope you’ll be able to help us with this important project to improve Medicare services.
Sincerely,

Marina Vornovitsky
Director, Medicare Current Beneficiary Survey
Centers for Medicare and Medicaid Services
OMB No. 0938-0568 | Expires 2/29/2024