OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

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

OMB 0938-0568 · HHS/CMS.

OMB 0938-0568

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 on sleep apnea, thyroid disease, and bowel disease, remove content that is no longer relevant to the goals of the survey, and update existing content to better meet the policy needs of CMS and stakeholders. To ensure the sustainability of the survey and to maintain a reasonable level of respondent burden, it is necessary to routinely review MCBS survey content and remove items that are no longer as relevant to the policy landscape or which are no longer performing well. The requested deletions are a result of a content reduction process that CMS developed in 2024 and is currently using to review MCBS survey content in the Community and Facility instruments. The goals of this process are three-fold: 1) to promote efficiency by streamlining the questionnaire and reducing respondent burden; 2) to continuously assess utility of information collected by the MCBS and remove questions that are no longer relevant, and 3) to maintain the production of high-quality data by removing content that is no longer performing well. For this full clearance revision, CMS has used the content reduction process to identify items that a) are low performing due to difficulty of administration or data quality issues, b) are no longer needed at the same frequency of administration, c) require updated question text or response options, or d) no longer match the existing healthcare landscape or require further evaluation.

The latest form for Medicare Current Beneficiary Survey (MCBS) (CMS-P-0015A) expires 2029-01-31 and is listed under ICR 202511-0938-005.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form CMS-P-0015A Facility Web Survey 3 - US_HSForm
Form CMS-P-0015A Facility Web Survey 2 - IN_EXForm
Form CMS-P-0015A Facility Web Survey 1 - FQ_RH_BQForm
Form CMS-P-0015A Debt QuestionaireForm
Form CMS-P-0015A Health_Status - HypertensionForm
Form CMS-P-0015A ImmunizationForm
Form CMS-P-0015A Telemedicine QuestionnaireForm
Form CMS-P-0015A Use of Health Services Section SpecificationsForm
Form CMS-P-0015A HFQ - Health Status and FunctioningForm
Form CMS-P-0015A Cognitive MeasuresForm
Form CMS-P-0015A Health_InsuranceForm
Form CMS-P-0015A QuestionaireForm
Form CMS-P-0015A Questionaire Missing DataForm
Form CMS-P-0015A ExpendituresForm
Form CMS-P-0015A Background_Questionnaire MIssing DataForm
Form CMS-P-0015A Background_QuestionnaireForm
Form CMS-P-0015A Health_StatusForm
Form CMS-P-0015A Residence HistoryForm
Form CMS-P-0015A Residence History Missing DataForm
Form CMS-P-0015A Facility ScreenerForm
Form CMS-P-0015A Facility ShowcardsForm
Form CMS-P-0015A Showcards and Reference CardsForm
Form CMS-P-0015A Preventive CareForm
Form CMS-P-0015A Beneficiary KnowledgeForm
Form CMS-P-0015A Statement Cost SeriesForm
Form CMS-P-0015A Satisfaction CareForm
Form CMS-P-0015A Prescribed Medicine UtilizationForm
Form CMS-P-0015A Outpatient UtilizationForm
Form CMS-P-0015A Other Medical ExpenseForm
Form CMS-P-0015A No Statement CostForm
Form CMS-P-0015A Nicotine AlcoholForm
Form CMS-P-0015A Medical Provider UtilzationForm
Form CMS-P-0015A IntroductionForm
Form CMS-P-0015A Institutional UtilizationForm
Form CMS-P-0015A Inpatient UtilizationForm
Form CMS-P-0015A Income_and_ AssetsForm
Form CMS-P-0015A Housing_CharacteristicsForm
Form CMS-P-0015A Home HealthForm
Form CMS-P-0015A Health InsuranceForm
Form CMS-P-0015A Emergency UtilizationForm
Form CMS-P-0015A Drug CoverageForm
Form CMS-P-0015A Dental, Vision, and Hearing Care UtilizationForm
Form CMS-P-0015A Chronic PainForm
Form CMS-P-0015A Care_CoordinationForm
Form CMS-P-0015A Post Statement CostForm
Form CMS-P-0015A Mobility of BeneficiariesForm
Form CMS-P-0015A Enumeration SummaryForm
Form CMS-P-0015A End QuestionaireForm
Form CMS-P-0015A Demographic IncomeForm
Form CMS-P-0015A Cost Payment SummaryForm
CMS-P-0015A 0938-0568_SSA.docxSupporting Statement A
CMS-P-0015A_0938-0568_SSB.docxSupporting Statement B
2027 Full Clearance 30-Day Crosswalk.docxSupplementary Document
Facility Web Survey Invitation Emails.pdfSupplementary Document
Facility Web Screener Letters.pdfSupplementary Document
Facility Web Reminder Letter.pdfSupplementary Document
Available by Web Continuing Facility Letter.pdfSupplementary Document
NonResponseLetterFraud.pdfSupplementary Document
HCStatementGPLetter.pdfSupplementary Document
FacThankYouLetter.pdfSupplementary Document
FacPrepInterviewLetter.pdfSupplementary Document
FacAdvLetterBillOffices.pdfSupplementary Document
ComLanguageInsert.pdfSupplementary Document
BaseThankYouLetter.pdfSupplementary Document
BaseFAQEnclosure.pdfSupplementary Document
MCBSFAQ.pdfSupplementary Document
ComAdvLetterCallUs.pdfSupplementary Document
CMSThankYouLetter.pdfSupplementary Document
ReminderPostcard.pdfSupplementary Document
ReminderLetter.pdfSupplementary Document
NonResponseLetter.pdfSupplementary Document
RedesignedComBrochure.pdfSupplementary Document
VideoInterviewingLetter.pdfSupplementary Document
ComAuthLetter.pdfSupplementary Document
ComAdvLetterContactYou.pdfSupplementary Document
MCBSFacilityBrochure.pdfSupplementary Document
FacAdvanceLetter.pdfSupplementary Document
Attachment 6. CAPI screenshots.pdfSupplementary Document
NextofKinForm.pdfSupplementary Document
ResConsentForm.pdfSupplementary Document
HIPAALetter.pdfSupplementary Document
MCBSCalendar.pdfSupplementary Document
MCBSRespondentNewsletter.pdfSupplementary Document
Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A) Form
Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A) Form
Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A) Form
Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A) Form
Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A) Form
Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A) Form
Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A) Form
Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A) Form
Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A) Form
Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A) Form
Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A) Form
Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A) Form
Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A) Form
Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A) Form
Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A) Form
Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A) Form
Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A) Form
Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A) Form
Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A) Form
Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A) Form
Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A) Form
Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A) Form
Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A) Form
Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A) Form
Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A) Form
Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A) Form
Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A) Form
Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A) Form
Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A) Form
Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A) Form
Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A) Form
Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A) Form
Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A) Form
Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A) Form
Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A) Form
Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A) Form
Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A) Form
Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A) Form
Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A) Form
Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A) Form
Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A) Form
Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A) Form
Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A) Form
Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A) Form
Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A) Form
Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A) Form
Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A) Form
Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A) Form
Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A) Form
Medicare Current Beneficiary Survey (MCBS):(CMS-P-0015A) Form

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202607-0938-013 Revision of a currently approved collection 2026-07-27
202511-0938-005 Revision of a currently approved collection 2025-11-21
202504-0938-006 No material or nonsubstantive change to a currently approved collection 2025-04-09
202407-0938-007 Revision of a currently approved collection 2024-07-24 Approved without change
202404-0938-001 No material or nonsubstantive change to a currently approved collection 2024-04-01 Approved without change
202306-0938-009 Revision of a currently approved collection 2023-06-26 Approved with change
202203-0938-013 Revision of a currently approved collection 2022-04-04 Approved with change
202105-0938-001 No material or nonsubstantive change to a currently approved collection 2021-05-05 Approved without change
202011-0938-011 Revision of a currently approved collection 2020-12-10
202006-0938-012 Revision of a currently approved collection 2020-06-16 Approved with change
202006-0938-011 No material or nonsubstantive change to a currently approved collection 2020-06-15 Approved without change
202004-0938-005 Revision of a currently approved collection 2020-04-28 Withdrawn and continue
202002-0938-004 No material or nonsubstantive change to a currently approved collection 2020-02-11 Approved with change
201912-0938-002 No material or nonsubstantive change to a currently approved collection 2019-12-03 Approved with change
201904-0938-012 Revision of a currently approved collection 2019-04-18 Approved with change
201805-0938-015 Revision of a currently approved collection 2018-05-23 Approved with change
201711-0938-002 No material or nonsubstantive change to a currently approved collection 2017-11-03 Approved with change
201702-0938-022 No material or nonsubstantive change to a currently approved collection 2017-02-27 Approved with change
201605-0938-004 Revision of a currently approved collection 2016-05-09 Approved with change
201601-0938-001 No material or nonsubstantive change to a currently approved collection 2016-01-15 Approved without change
201509-0938-011 No material or nonsubstantive change to a currently approved collection 2015-09-24 Approved without change
201506-0938-011 No material or nonsubstantive change to a currently approved collection 2015-06-24 Approved with change
201311-0938-005 Revision of a currently approved collection 2013-11-08 Approved without change
201202-0938-008 No material or nonsubstantive change to a currently approved collection 2012-02-29 Approved with change
201008-0938-025 Revision of a currently approved collection 2010-08-31 Approved with change
200703-0938-003 Extension without change of a currently approved collection 2007-03-12 Approved without change
200401-0938-003 Extension without change of a currently approved collection 2004-01-14 Approved without change
200012-0938-001 Extension without change of a currently approved collection 2000-12-01 Approved without change
199710-0938-007 Revision of a currently approved collection 1997-10-31 Approved without change
199702-0938-006 Revision of a currently approved collection 1997-02-20 Approved without change
199702-0938-004 Revision of a currently approved collection 1997-02-20 Approved without change
199606-0938-002 Revision of a currently approved collection 1996-06-19 Approved without change
199503-0938-005 Revision of a currently approved collection 1995-03-10 Approved without change
199409-0938-010 Extension without change of a currently approved collection 1994-09-19 Approved without change
199306-0938-014 Revision of a currently approved collection 1993-06-29 Approved without change
199109-0938-008 Revision of a currently approved collection 1991-09-27 Approved without change
199105-0938-009 Revision of a currently approved collection 1991-05-09 Approved without change
199101-0938-005 No material or nonsubstantive change to a currently approved collection 1991-01-02 Approved with change
199007-0938-009 New collection (Request for a new OMB Control Number) 1990-07-30 Approved without change