Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Adult SAQ Modified 6198 723 47226 Form and Instruction 49
Authorization Form for the MEPS-MPC Provider and Pharmacy Survey Modified 62597 3130 204452 Form and Instruction 51
Form and Instruction 52
Burdens and Economic Impacts of Medical Care SAQ Removed 0 0 0 Form and Instruction 63
Diabetes Care SAQ Removed 0 0 0 Form and Instruction 50
Home Health Care Providers Event Form Modified 2858 143 6266 Form and Instruction 55
Form and Instruction 56
Hospitals Event Form Modified 19638 982 43031 Form and Instruction 59
Institutions (non-hospital) Event Form Modified 129 6 263 Form and Instruction 60
MEPS-HC Core Interview Modified 25875 37519 2450741 Form and Instruction 1
Form and Instruction 2
Form and Instruction 3
Form and Instruction 4
Form and Instruction 5
Form and Instruction 6
Form and Instruction 7
Form and Instruction 8
Form and Instruction 9
Form and Instruction 10
Form and Instruction 11
Form and Instruction 12
Form and Instruction 13
Form and Instruction 14
Form and Instruction 15
Form and Instruction 16
Form and Instruction 17
Form and Instruction 18
Form and Instruction 19
Form and Instruction 20
Form and Instruction 21
Form and Instruction 22
Form and Instruction 23
Form and Instruction 24
Form and Instruction 25
Form and Instruction 26
Form and Instruction 27
Form and Instruction 28
Form and Instruction 29
Form and Instruction 30
Form and Instruction 31
Form and Instruction 32
Form and Instruction 33
Form and Instruction 34
Form and Instruction 35
Form and Instruction 36
Form and Instruction 37
Form and Instruction 38
Form and Instruction 39
Form and Instruction 40
Form and Instruction 41
Form and Instruction 42
Form and Instruction 43
Form and Instruction 45
Form and Instruction 46
Form and Instruction 47
MEPS-HC Validation Interview Modified 1491 124 8100 Form and Instruction 53b
Form and Instruction 53a
MPC Contact Guide/Screening Call Modified 36370 3031 132818 Form and Instruction 54
Office Based Providers Form Modified 28905 1445 63320 Form and Instruction 57
Pharmacies Event Form Modified 42469 2123 91459 Form and Instruction 61
Preventive Care SAQ Modified 6198 723 47226 Form and Instruction 50
Separately Billing Doctors Form Modified 6299 315 13803 Form and Instruction 58
Total burden requested under this ICR: 239027 50264 3108705  
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