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 Facility Web Survey 3 - US_HS	Form	Modified	Available
Form CMS-P-0015A Facility Web Survey 2 - IN_EX	Form	Modified	Available
Form CMS-P-0015A Facility Web Survey 1 - FQ_RH_BQ	Form	Modified	Available
Form CMS-P-0015A Debt Questionaire	Form	Modified	Available
Form CMS-P-0015A Health_Status - Hypertension	Form	Modified	Available
Form CMS-P-0015A Immunization	Form	Modified	Available
Form CMS-P-0015A Telemedicine Questionnaire	Form	Modified	Available
Form CMS-P-0015A Use of Health Services Section Specifications	Form	Modified	Available
Form CMS-P-0015A HFQ - Health Status and Functioning	Form	Modified	Available
Form CMS-P-0015A Cognitive Measures	Form	Modified	Available
Form CMS-P-0015A Health_Insurance	Form	Modified	Available
Form CMS-P-0015A Questionaire	Form	Modified	Available
Form CMS-P-0015A Questionaire Missing Data	Form	Modified	Available
Form CMS-P-0015A Expenditures	Form	Modified	Available
Form CMS-P-0015A Background_Questionnaire MIssing Data	Form	Modified	Available
Form CMS-P-0015A Background_Questionnaire	Form	Modified	Available
Form CMS-P-0015A Health_Status	Form	Modified	Available
Form CMS-P-0015A Residence History	Form	Modified	Available
Form CMS-P-0015A Residence History Missing Data	Form	Modified	Available
Form CMS-P-0015A Facility Screener	Form	Modified	Available
Form CMS-P-0015A Facility Showcards	Form	Modified	Available
Form CMS-P-0015A Showcards and Reference Cards	Form	Modified	Available
Form CMS-P-0015A Preventive Care	Form	Modified	Available
Form CMS-P-0015A Beneficiary Knowledge	Form	Modified	Available
Form CMS-P-0015A Statement Cost Series	Form	Modified	Available
Form CMS-P-0015A Satisfaction Care	Form	Modified	Available
Form CMS-P-0015A Prescribed Medicine Utilization	Form	Modified	Available
Form CMS-P-0015A Outpatient Utilization	Form	Modified	Available
Form CMS-P-0015A Other Medical Expense	Form	Modified	Available
Form CMS-P-0015A No Statement Cost	Form	Modified	Available
Form CMS-P-0015A Nicotine Alcohol	Form	Modified	Available
Form CMS-P-0015A Medical Provider Utilzation	Form	Modified	Available
Form CMS-P-0015A Introduction	Form	Modified	Available
Form CMS-P-0015A Institutional Utilization	Form	Modified	Available
Form CMS-P-0015A Inpatient Utilization	Form	Modified	Available
Form CMS-P-0015A Income_and_ Assets	Form	Modified	Available
Form CMS-P-0015A Housing_Characteristics	Form	Modified	Available
Form CMS-P-0015A Home Health	Form	Modified	Available
Form CMS-P-0015A Health Insurance	Form	Modified	Available
Form CMS-P-0015A Emergency Utilization	Form	Modified	Available
Form CMS-P-0015A Drug Coverage	Form	Modified	Available
Form CMS-P-0015A Dental, Vision, and Hearing Care Utilization	Form	Modified	Available
Form CMS-P-0015A Chronic Pain	Form	Modified	Available
Form CMS-P-0015A Care_Coordination	Form	Modified	Available
Form CMS-P-0015A Post Statement Cost	Form	Modified	Available
Form CMS-P-0015A Mobility of Beneficiaries	Form	Modified	Available
Form CMS-P-0015A Enumeration Summary	Form	Modified	Available
Form CMS-P-0015A End Questionaire	Form	Modified	Available
Form CMS-P-0015A Demographic Income	Form	Modified	Available
Form CMS-P-0015A Cost Payment Summary	Form	Modified	Available
CMS-P-0015A 0938-0568_SSA.docx	Supporting Statement A	Uploaded 2026-07-24	Available
CMS-P-0015A_0938-0568_SSB.docx	Supporting Statement B	Uploaded 2026-07-24	Available
2027 Full Clearance 30-Day Crosswalk.docx	Supplementary Document	Uploaded 2026-07-23	Available
Facility Web Survey Invitation Emails.pdf	Supplementary Document	Uploaded 2026-07-23	Available
Facility Web Screener Letters.pdf	Supplementary Document	Uploaded 2026-07-23	Available
Facility Web Reminder Letter.pdf	Supplementary Document	Uploaded 2026-07-23	Available
Available by Web Continuing Facility Letter.pdf	Supplementary Document	Uploaded 2026-07-23	Available
NonResponseLetterFraud.pdf	Supplementary Document	Uploaded 2026-07-23	Available
HCStatementGPLetter.pdf	Supplementary Document	Uploaded 2026-07-23	Available
FacThankYouLetter.pdf	Supplementary Document	Uploaded 2026-07-23	Available
FacPrepInterviewLetter.pdf	Supplementary Document	Uploaded 2026-07-23	Available
FacAdvLetterBillOffices.pdf	Supplementary Document	Uploaded 2026-07-23	Available
ComLanguageInsert.pdf	Supplementary Document	Uploaded 2026-07-23	Available
BaseThankYouLetter.pdf	Supplementary Document	Uploaded 2026-07-23	Available
BaseFAQEnclosure.pdf	Supplementary Document	Uploaded 2026-07-23	Available
MCBSFAQ.pdf	Supplementary Document	Uploaded 2026-07-23	Available
ComAdvLetterCallUs.pdf	Supplementary Document	Uploaded 2026-07-23	Available
CMSThankYouLetter.pdf	Supplementary Document	Uploaded 2026-07-23	Available
ReminderPostcard.pdf	Supplementary Document	Uploaded 2026-07-23	Available
ReminderLetter.pdf	Supplementary Document	Uploaded 2026-07-23	Available
NonResponseLetter.pdf	Supplementary Document	Uploaded 2026-07-23	Available
RedesignedComBrochure.pdf	Supplementary Document	Uploaded 2026-07-23	Available
VideoInterviewingLetter.pdf	Supplementary Document	Uploaded 2026-07-23	Available
ComAuthLetter.pdf	Supplementary Document	Uploaded 2026-07-23	Available
ComAdvLetterContactYou.pdf	Supplementary Document	Uploaded 2026-07-23	Available
MCBSFacilityBrochure.pdf	Supplementary Document	Uploaded 2026-07-23	Available
FacAdvanceLetter.pdf	Supplementary Document	Uploaded 2026-07-23	Available
Attachment 6. CAPI screenshots.pdf	Supplementary Document	Uploaded 2026-07-23	Available
NextofKinForm.pdf	Supplementary Document	Uploaded 2026-07-23	Available
ResConsentForm.pdf	Supplementary Document	Uploaded 2026-07-23	Available
HIPAALetter.pdf	Supplementary Document	Uploaded 2026-07-23	Available
MCBSCalendar.pdf	Supplementary Document	Uploaded 2026-07-23	Available
MCBSRespondentNewsletter.pdf	Supplementary Document	Uploaded 2026-07-23	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
8171	Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A)	Form	Modified	Facility Web Survey 3 - US_HS
8171	Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A)	Form	Modified	Facility Web Survey 2 - IN_EX
8171	Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A)	Form	Modified	Facility Web Survey 1 - FQ_RH_BQ
8171	Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A)	Form	Modified	Debt Questionaire
8171	Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A)	Form	Modified	Health_Status - Hypertension
8171	Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A)	Form	Modified	Immunization
8171	Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A)	Form	Modified	Telemedicine Questionnaire
8171	Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A)	Form	Modified	Use of Health Services Section Specifications
8171	Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A)	Form	Modified	HFQ - Health Status and Functioning
8171	Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A)	Form	Modified	Cognitive Measures
8171	Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A)	Form	Modified	Health_Insurance
8171	Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A)	Form	Modified	Questionaire
8171	Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A)	Form	Modified	Questionaire Missing Data
8171	Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A)	Form	Modified	Expenditures
8171	Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A)	Form	Modified	Background_Questionnaire MIssing Data
8171	Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A)	Form	Modified	Background_Questionnaire
8171	Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A)	Form	Modified	Health_Status
8171	Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A)	Form	Modified	Residence History
8171	Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A)	Form	Modified	Residence History Missing Data
8171	Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A)	Form	Modified	Facility Screener
8171	Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A)	Form	Modified	Facility Showcards
8171	Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A)	Form	Modified	Showcards and Reference Cards
8171	Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A)	Form	Modified	Preventive Care
8171	Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A)	Form	Modified	Beneficiary Knowledge
8171	Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A)	Form	Modified	Statement Cost Series
8171	Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A)	Form	Modified	Satisfaction Care
8171	Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A)	Form	Modified	Prescribed Medicine Utilization
8171	Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A)	Form	Modified	Outpatient Utilization
8171	Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A)	Form	Modified	Other Medical Expense
8171	Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A)	Form	Modified	No Statement Cost
8171	Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A)	Form	Modified	Nicotine Alcohol
8171	Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A)	Form	Modified	Medical Provider Utilzation
8171	Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A)	Form	Modified	Introduction
8171	Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A)	Form	Modified	Institutional Utilization
8171	Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A)	Form	Modified	Inpatient Utilization
8171	Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A)	Form	Modified	Income_and_ Assets
8171	Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A)	Form	Modified	Housing_Characteristics
8171	Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A)	Form	Modified	Home Health
8171	Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A)	Form	Modified	Health Insurance
8171	Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A)	Form	Modified	Emergency Utilization
8171	Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A)	Form	Modified	Drug Coverage
8171	Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A)	Form	Modified	Dental, Vision, and Hearing Care Utilization
8171	Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A)	Form	Modified	Chronic Pain
8171	Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A)	Form	Modified	Care_Coordination
8171	Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A)	Form	Modified	Post Statement Cost
8171	Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A)	Form	Modified	Mobility of Beneficiaries
8171	Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A)	Form	Modified	Enumeration Summary
8171	Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A)	Form	Modified	End Questionaire
8171	Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A)	Form	Modified	Demographic Income
8171	Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A)	Form	Modified	Cost Payment Summary

ICR Details

OMB Control No: 0938-0568	ICR Reference No: 202607-0938-013
Status: Received in OIRA	Previous ICR Reference No: 202511-0938-005
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: 07/27/2026

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	01/31/2029
Responses	35,015	35,015
Time Burden (Hours)	31,917	32,258
Cost Burden (Dollars)	0	0

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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 MCBS has been at the forefront of survey collection and data processing, most notably as one of the first surveys to successfully 1) implement a computer assisted personal interview (CAPI) and 2) match survey and claims data to adjust and correct for underreporting in survey reported health care utilization. The CMS vision for the MCBS is to continue to provide timely, policy-relevant, unique, high-quality, and high-value data; increase the survey’s ability to develop, monitor, assess, and evaluate the impact of CMS care delivery and payment models; and to continue to break ground in innovative, efficient, and analytically powerful new areas of survey data administration, design, and development. CMS routinely reviews MCBS content to: 1) promote efficiency by streamlining the questionnaire and reducing respondent burden; 2) assess utility of information collected by the MCBS and remove questions that are no longer relevant, and 3) maintain the production of high-quality data by removing content that is no longer performing well. Starting with the 2026 full clearance revisions (approved by OMB on 1/6/2026), CMS reduced MCBS respondent burden by 8%. In accordance with OMB’s terms of clearance specified in the approval of the 2026 MCBS, CMS identified additional deletions in the Community and Facility instruments to reduce the respondent burden associated with the MCBS. When implemented, the revision to this OMB package will continue the downward trend in respondent burden with a net decrease of an additional one percent.

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

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 23271	04/30/2026
30-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 46785	07/24/2026
Did the Agency receive public comments on this ICR? No

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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-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, 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 ,   Care_Coordination ,   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 ,   Showcards and Reference Cards ,   Facility Showcards ,   Facility Screener ,   Residence History Missing Data ,   Residence History ,   Health_Status ,   Background_Questionnaire ,   Background_Questionnaire MIssing Data ,   Expenditures ,   Questionaire Missing Data ,   Questionaire ,   Health_Insurance ,   Cognitive Measures ,   HFQ - Health Status and Functioning ,   Use of Health Services Section Specifications ,   Telemedicine Questionnaire ,   Immunization ,   Health_Status - Hypertension ,   Debt Questionaire ,   Facility Web Survey 1 - FQ_RH_BQ ,   Facility Web Survey 2 - IN_EX ,   Facility Web Survey 3 - US_HS

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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)	31,917	32,258	0	-341	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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

Burden Increase Due to:

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

Burden Reduction Due to: Miscellaneous Actions

Short Statement: CMS reduced the collections overall burden due to planned content removals and revisions . These changes include the removal and revision of existing survey items. Some of the item revisions are burden neutral, such as simplification of item text and response options, while others will reduce interview length, such as changing the item administration schedule. The revision reduces the annual respondent burden by 341 hours, bringing the total annual respondent burden to 31,917 hours.

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Annual Cost to Federal Government: $22,300,000

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

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Common Form ICR:  No

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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: 07/27/2026

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