Test of the MCBS Pulse Supplement: Beneficiary Trust

Generic Clearance for Questionnaire Testing and Methodological Research for the Medicare Current Beneficiary Survey (MCBS) (CMS-10549)

Documents and Forms

Document Name Document Type
Form CMS-10549 Test of the MCBS Pulse Supplement: Beneficiary Trust Form and Instruction
CMS-10549 Test Questionnaire Attachment F. MCBS Rapid Cycle Specs.pdf Form and Instruction
Supporting Statement_MCBS Beneficiary Trust Supplement_.docx Supporting Statement IC Document
Attachment A. Community Advance Letter.docx Community Advance Letter IC Document
Attachment B. Contacting Guide.docx Contacting Guide IC Document
Attachment C. Reminder Postcard.docx Reminder Postcard IC Document
Attachment D. Frequently Asked Questions_2021 Panel.docx Frequently Asked Questions_2021 Panel IC Document
Attachment E. Frequently Asked Questions_2022-2024 Panels.docx Frequently Asked Questions_2022-2024 Panels IC Document

Information Collection (IC) Details

IC Title:	Test of the MCBS Pulse Supplement: Beneficiary Trust	Agency IC Tracking Number:	OEDA

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10549	Test Questionnaire	Attachment F. MCBS Rapid Cycle Specs.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 5,800	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	5,800	5,800
Annual IC Time Burden (Hours)	1,624	1,624
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement	Supporting Statement_MCBS Beneficiary Trust Supplement_.docx	09/15/2025
Community Advance Letter	Attachment A. Community Advance Letter.docx	09/15/2025
Contacting Guide	Attachment B. Contacting Guide.docx	09/15/2025
Reminder Postcard	Attachment C. Reminder Postcard.docx	09/15/2025
Frequently Asked Questions_2021 Panel	Attachment D. Frequently Asked Questions_2021 Panel.docx	09/15/2025
Frequently Asked Questions_2022-2024 Panels	Attachment E. Frequently Asked Questions_2022-2024 Panels.docx	09/15/2025

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.