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View Information Collection (IC)

MEPS-HC Core Interview
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-CAPI Specs Attachment 28 -- HC Access to Care Section.doc Yes Yes Fillable Fileable
Other-CAPI Specs Attachment 29 -- HC Accident, Injury & Conditions Section.doc Yes Yes Fillable Fileable
Other-CAPI Specs Attachment 30 -- HC Assets Section.doc Yes Yes Fillable Fileable
Other-CAPI Specs Attachment 31 -- HC Calendar Section.doc Yes Yes Fillable Fileable
Other-CAPI Specs Attachment 32 -- HC Charge Payment Section.doc Yes Yes Fillable Fileable
Other-CAPI Specs Attachment 33 -- HC Child Preventive Health Supplement Section.doc Yes Yes Fillable Fileable
Other-CAPI Specs Attachment 34 -- HC Condition Enumeration Section.doc Yes Yes Fillable Fileable
Other-CAPI Specs Attachment 35 -- HC Dental Care Section.doc Yes Yes Fillable Fileable
Other-CAPI Specs Attachment 36 -- HC Disability Days Section.doc Yes Yes Fillable Fileable
Other-CAPI Specs Attachment 37 -- HC Emergency Room Section.doc Yes Yes Fillable Fileable
Other-CAPI Specs Attachment 38 -- HC Employment Driver Section.doc Yes Yes Fillable Fileable
Other-CAPI Specs Attachment 39 -- HC Employment Section.doc Yes Yes Fillable Fileable
Other-CAPI Specs Attachment 40 -- HC Employment Wage Section.doc Yes Yes Fillable Fileable
Other-CAPI Specs Attachment 41 -- HC Event Roster Section.doc Yes Yes Fillable Fileable
Other-CAPI Specs Attachment 42 -- HC Flat Fee Section.doc Yes Yes Fillable Fileable
Other-CAPI Specs Attachment 43 -- HC Health Insurance Section.doc Yes Yes Fillable Fileable
Other-CAPI Specs Attachment 46 -- HC Hospital Stay Section.doc Yes Yes Fillable Fileable
Other-CAPI Specs Attachment 44 -- HC Health Status Section.doc Yes Yes Fillable Fileable
Other-CAPI Specs Attachment 45 -- HC Home Health Section.doc Yes Yes Fillable Fileable
Other-CAPI Specs Attachment 47 -- HC Income Section.doc Yes Yes Fillable Fileable
Other-CAPI Specs Attachment 48 -- HC Managed Care Section.doc Yes Yes Fillable Fileable
Other-CAPI Specs Attachment 49 -- HC Medical Provider Visits Section.doc Yes Yes Fillable Fileable
Other-CAPI Specs Attachment 50 -- HC Old Employment & Private Related Insurance Section.doc Yes Yes Fillable Fileable
Other-CAPI Specs Attachment 51 -- HC Old Public Related Insurance Section.doc Yes Yes Fillable Fileable
Other-CAPI Specs Attachment 52 -- HC Other Medical Expenses Section.doc Yes Yes Fillable Fileable
Other-CAPI Specs Attachment 53 -- HC Outpatient Department Section.doc Yes Yes Fillable Fileable
Other-CAPI Specs Attachment 54 -- HC Prescribed Medicines Section.doc Yes Yes Fillable Fileable
Other-CAPI Specs Attachment 55 -- HC Preventive Care Section.doc Yes Yes Fillable Fileable
Other-CAPI Specs Attachment 56 -- HC Priority Conditions Enumeration Section.doc Yes Yes Fillable Fileable
Other-CAPI Specs Attachment 57 -- HC Private Health Insurance Detail Section.doc Yes Yes Fillable Fileable
Other-CAPI Specs Attachment 58 -- HC Provider Directory Section.doc Yes Yes Fillable Fileable
Other-CAPI Specs Attachment 59 -- HC Provider Probes Section.doc Yes Yes Fillable Fileable
Other-CAPI Specs Attachment 60 -- HC Provider Roster Section.doc Yes Yes Fillable Fileable
Other-CAPI Specs Attachment 61 -- HC Quality (Priority Conditions) Supplement Section.doc Yes Yes Fillable Fileable
Other-CAPI Specs Attachment 62 -- HC Reenumeration Subsection A.doc Yes Yes Fillable Fileable
Other-CAPI Specs Attachment 63 -- HC Reenumeration Subsection B.doc Yes Yes Fillable Fileable
Other-CAPI Specs Attachment 64 -- HC Review of Employment Information Section.doc Yes Yes Fillable Fileable
Other-CAPI Specs Attachment 65 -- HC Satisfaction with Health Plan Section.doc Yes Yes Fillable Fileable
Other-CAPI Specs Attachment 66 -- HC Time Period Covered Detail Section.doc Yes Yes Fillable Fileable
Other-CAPI Specs Attachment 67 -- HC Information Screen Section.doc Yes Yes Fillable Fileable
Other-CAPI Specs Attachment 68 -- HC F1 Help Text.doc Yes Yes Fillable Fileable
Other-CAPI Specs Attachment 69 -- HC Closing Section.doc Yes Yes Fillable Fileable

Health Consumer Health and Safety

 

15,000 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 37,500 0 -95,048 0 0 132,548
Annual IC Time Burden (Hours) 56,250 0 -28,934 0 0 85,184
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Attachment 2 -- HC About MEPS Booklet Attachment 2 -- HC About MEPS Booklet.pdf 08/21/2009
Attachment 3 -- HC About MEPS-MPC Permission Form Attachment 3 -- HC About MEPS-MPC Permission Form.doc 08/21/2009
Attachment 4 -- HC Appointment Reminder Postcard Attachment 4 -- HC Appointment Reminder Postcard.pdf 08/21/2009
Attachment 5 -- HC Community Authority Letter Attachment 5 -- HC Community Authority Letter.doc 08/21/2009
Attachment 6 -- HC Data protection is word ONE with MEPS Attachment 6 -- HC Data protection is word ONE with MEPS.doc 08/21/2009
Attachment 7 -- HC DVD Companion Booklet Attachment 7 -- HC DVD Companion Booklet.doc 08/21/2009
Attachment 8 -- HC Respondent Recruitment DVD Attachment 8 -- HC Respondent Recruitment DVD.doc 08/21/2009
Attachment 9 -- HC Important Information About Your Participation in MEPS Attachment 9 -- HC Important Information About Your Participation in MEPS.doc 08/21/2009
Attachment 10 -- HC MEPS Change of Address Card Attachment 10 -- HC MEPS Change of Address Card.pdf 08/21/2009
Attachment 11 -- HC MEPS Data Example & FAQs Attachment 11 -- HC MEPS Data Example & FAQs.doc 08/21/2009
Attachment 12 -- HC Rd 1 Prenotification Letter Attachment 12 -- HC Rd 1 Prenotification Letter.doc 08/21/2009
Attachment 13 -- HC Rd 1 Respondent Materials Cover Letter Attachment 13 -- HC Rd 1 Respondent Materials Cover Letter.doc 08/21/2009
Attachment 14 -- HC Rd 3 Advance Letter 1 Attachment 14 -- HC Rd 3 Advance Letter 1.doc 08/21/2009
Attachment 15 -- HC Rd 3 Advance Letter 2 Attachment 15 -- HC Rd 3 Advance Letter 2.doc 08/21/2009
Attachment 16 -- HC Rd 5 Advance Letter 1 Attachment 16 -- HC Rd 5 Advance Letter 1.doc 08/21/2009
Attachment 17 -- HC Rd 5 Advance Letter 2 Attachment 17 -- HC Rd 5 Advance Letter 2.doc 08/21/2009
Attachment 18 -- HC Rds 2 & 4 Advance Letter Attachment 18 -- HC Rds 2 & 4 Advance Letter.doc 08/21/2009
Attachment 19 -- HC MEPS FAQs Brochure Attachment 19 -- HC MEPS FAQs Brochure.doc 08/21/2009
Attachment 20 -- HC MEPS Monthly Planner Attachment 20 -- HC MEPS Monthly Planner.pdf 08/21/2009
Attachment 21 -- HC MEPS Record Keeper Attachment 21 -- HC MEPS Record Keeper.pdf 08/21/2009
Attachment 23 -- HC Showcards Attachment 23 -- HC Showcards.doc 08/21/2009
Attachment 24 -- HC Sorry I Missed You Note Attachment 24 -- HC Sorry I Missed You Note.pdf 08/21/2009
Attachment 25 -- HC Thank You Note Attachment 25 -- HC Thank You Note.pdf 08/21/2009
Attachment 26 -- HC Validation Letter Attachment 26 -- HC Validation Letter.doc 08/21/2009
Attachment 27 -- HC Users of MEPS Data Handout Attachment 27 -- HC Users of MEPS Data Handout.doc 08/21/2009
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.