OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

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

ICR 202011-0938-011 · OMB 0938-0568 · Received in OIRA

Forms and Documents
Document
Name
Status
Form
 Modified
Supporting Statement A
2020-12-07
Supporting Statement B
2020-12-07
Supplementary Document
2020-11-23
Supplementary Document
2020-11-23
Supplementary Document
2020-11-23
Supplementary Document
2020-11-23
Supplementary Document
2020-11-23
Supplementary Document
2020-11-23
Supplementary Document
2020-11-23
Supplementary Document
2020-11-23
Supplementary Document
2020-11-23
Supplementary Document
2020-11-23
Supplementary Document
2020-11-23
Supplementary Document
2020-11-23
Supplementary Document
2020-11-23
Supplementary Document
2020-11-23
Supplementary Document
2020-11-23
Supplementary Document
2020-11-23
Supplementary Document
2020-11-23
Supplementary Document
2020-11-23
Supplementary Document
2020-11-23
Supplementary Document
2020-08-19
Supplementary Document
2020-11-23
Supplementary Document
2020-11-23
Supplementary Document
2020-11-23
Supplementary Document
2019-04-16
Supplementary Document
2020-11-23
Supplementary Document
2020-11-23
Supplementary Document
2020-11-23
IC Document Collections
IC ID
Document
Title
Status
8171 Modified
ICR Details
0938-0568 202011-0938-011
Received in OIRA 202006-0938-012
HHS/CMS OEDA
Medicare Current Beneficiary Survey (MCBS) (CMS-P-0015A)
Revision of a currently approved collection   No
Regular 12/10/2020
  Requested Previously Approved
36 Months From Approved 08/31/2023
35,998 35,998
54,426 44,363
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
  85 FR 57215 09/15/2020
85 FR 78853 12/07/2020
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, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, CMS-P-0015A, P-0015A, P-0015A Health Status ,   Outpatient Utilization ,   Post Statement Cost ,   Health Insurance ,   Beneficiary Knowledge ,   Residence History Missing Data ,   Use of Health Services ,   Expenditures ,   Questionaire Missing Data ,   Questionaire ,   Health_Insurance ,   Nicotine Alcohol ,   Medical Provider Utilzation ,   Usual Source of Care ,   Residence History ,   Health_Status ,   Chronic Pain ,   Access to Care ,   Dental, Vision, and Hearing Care Utilization ,   Drug Coverage ,   Housing_Characteristics ,   Income_and_ Assets ,   Inpatient Utilization ,   Institutional Utilization ,   Other Medical Expense ,   Prescribed Medicine Utilization ,   Showcards and Reference Cards ,   Background_Questionnaire ,   interviewer Remarks ,   End Questionaire ,   Mobility of Beneficiaries ,   Emergency Utilization ,   Home Health ,   Introduction ,   No Statement Cost ,   Satisfaction Care ,   Statement Cost Series ,   Preventive Care ,   Facility Showcards ,   Facility Screener ,   Background_Questionnaire MIssing Data ,   Cost Payment Summary ,   Demographic Income ,   Enumeration Summary ,   Home Health Summary ,   Health_Status_and_Functioning ,   interviewer Remarks ,   Cognitive Measures ,   Physical_Measures ,   COVID-19 Questionnaire Specifications ,   MCBS COVID-19 Winter 2021 Facility Supplement
  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 35,998 35,998 0 0 0 0
Annual Time Burden (Hours) 54,426 44,363 0 10,063 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
The COVID-19 items are estimated to add 15 minutes to the Community and Facility instruments each round starting in 2021; in addition, 1 minute of burden will be added to each Fall interview beginning in Fall 2021 Round 91 due to the addition of 3 new questions, 2 on housing insecurity and 1 on social isolation. Last, the burden reflects the one-time collection of COVID-19 questions (15 minutes per interview) for the NGACO sample. As a result, the total burden has increased to 54,426 from the previously approved total burden of 44,363. This is a net increase of 10,063 burden hours annually.
$24,215,710
Yes Part B of Supporting Statement
    No
    No
Yes
No
No
No
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.
12/10/2020