Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Attachment 20 HC Adult SAQ Female Unchanged 12984 1515 0 Form and Instruction Attachment 20
Form and Instruction Attachment 19
3. Veteran SAQ Removed 0 0 0 Form and Instruction Attachment 21
Attachment 19 – HC Adult SAQ – Male Unchanged 11985 1398 0 Form and Instruction Attachment 19
Form and Instruction Attachment 18
Authorization form for the MEPS-MPC Pharmacy Survey Unchanged 39692 1985 0 Form and Instruction Attachment 24
Authorization form for the MEPS-MPC Provider Survey Unchanged 69142 3457 0 Form and Instruction Attachment 25
Diabetes Care SAQ Unchanged 2072 104 0 Form and Instruction Attachment 22
Form and Instruction Attachment 23
HC Adult SAQ that includes Mental Health Questions New 20476 1194 0 Form and Instruction 106a
Form and Instruction 106b
Health Insurance Cost Sharing Collection- 2020 New 8135 6101 0 Form and Instruction 107a
Form and Instruction 107b
Form and Instruction 107c
Form and Instruction 107d
Home care for health care providers questionnaire Unchanged 972 146 0 Form and Instruction Attachment 78
Home care for non health care providers questionnaire Unchanged 11 2 0 Form and Instruction Attachment 82
Hospitals questionnaire Unchanged 17311 2597 0 Form and Instruction Attachment 91
Institutions (non-hospital) questionnaire Unchanged 238 36 0 Form and Instruction Attachment 96
MEPS-HC Core Interview Unchanged 33345 51129 0 Form and Instruction Attachment 29
Form and Instruction Attachment 30
Form and Instruction Attachment 31
Form and Instruction Attachment 32
Form and Instruction Attachment 33
Form and Instruction Attachment 34
Form and Instruction Attachment 35
Form and Instruction Attachment 36
Form and Instruction Attachment 37
Form and Instruction Attachment 38
Form and Instruction Attachment 39
Form and Instruction Attachment 40
Form and Instruction Attachment 41
Form and Instruction Attachment 42
Form and Instruction Attachment 43
Form and Instruction Attachment 44
Form and Instruction Attachment 45
Form and Instruction Attachment 46
Form and Instruction Attachment 47
Form and Instruction Attachment 48
Form and Instruction Attachment 49
Form and Instruction Attachment 50
Form and Instruction Attachment 51
Form and Instruction Attachment 52 HC
Form and Instruction Attachment 53
Form and Instruction Attachment 54
Form and Instruction Attachment 55
Form and Instruction Attachment 56
Form and Instruction Attachment 57
Form and Instruction Attachment 58
Form and Instruction Attachment 59
Form and Instruction Attachment 60
Form and Instruction Attachment 61
Form and Instruction Attachment 62
Form and Instruction Attachment 63
Form and Instruction Attachment 64
Form and Instruction Attachment 65
Form and Instruction Attachment 66
Form and Instruction Attachment 67
Form and Instruction Attachment 68
Form and Instruction Attachment 69
Form and Instruction Attachment 70
Form and Instruction Attachment 71
MEPS-HC Validation Interview Unchanged 4225 352 0 Form and Instruction Attachment 26
MPC Contact Guide/Screening Call Unchanged 36598 1220 0 Form and Instruction Attachment 72
Form and Instruction Attachment 73
Form and Instruction Attachment 74
Form and Instruction Attachment 75
Form and Instruction Attachment 76
Form and Instruction Attachment 77
Office based providers questionnaire Unchanged 18497 3083 0 Form and Instruction Attachment 83
Pharmacies questionnaire Unchanged 20203 1010 0 Form and Instruction Attachment 98
Pilot Test on Sampling NHIS Nonrespondents – 2020, R1 only of MEPS Core New 200 307 0 Form and Instruction 108
Separately billing doctors questionnaire Unchanged 42894 9294 0 Form and Instruction Attachment 87
Total burden requested under this ICR: 338980 84930 0  
To view an IC, click on IC Title