OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

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

ICR 201912-0938-002 · OMB 0938-0568 · Historical Active

Forms and Documents
Document
Name
Status
Form
 Modified
Supporting Statement A
2019-12-03
Justification for No Material/Nonsubstantive Change
2020-01-10
Supplementary Document
2019-08-06
Supplementary Document
2019-08-06
Supplementary Document
2019-08-06
Supplementary Document
2019-04-16
Supplementary Document
2019-04-16
Supplementary Document
2019-04-16
Supplementary Document
2019-04-16
Supplementary Document
2019-04-16
Supplementary Document
2019-04-16
Supplementary Document
2019-04-16
Supplementary Document
2019-04-16
Supplementary Document
2019-04-16
Supplementary Document
2019-04-16
Supplementary Document
2019-04-16
Supplementary Document
2019-04-16
Supplementary Document
2019-04-16
Supplementary Document
2019-04-16
Supporting Statement B
2019-08-06
IC Document Collections
IC ID
Document
Title
Status
8171 Modified
ICR Details
0938-0568 201912-0938-002
Historical Active 201904-0938-012
HHS/CMS OEDA
Medicare Current Beneficiary Survey (MCBS) (CMS-P-0015A)
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved with change 01/13/2020
Retrieve Notice of Action (NOA) 12/03/2019
  Inventory as of this Action Requested Previously Approved
08/31/2022 08/31/2022 08/31/2022
35,998 0 35,998
42,610 0 42,610
0 0 0
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.
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
  
None
Not associated with rulemaking
  84 FR 731 01/31/2019
84 FR 15617 04/16/2019
No
1
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, 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 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 ,   Health Status ,   Cost Payment Summary ,   Demographic Income ,   End Questionaire ,   Enumeration Summary ,   Home Health Summary ,   nterviewer Remarks ,   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
  Total Approved 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 35,998 35,998 0 0 0 0
Annual Time Burden (Hours) 42,610 42,610 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$23,347,008
Yes Part B of Supporting Statement
    No
    No
Yes
No
No
Uncollected
Stephan McKenzie 410 786-1943 stephan.mckenzie@cms.hhs.gov
  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
12/03/2019