View Information Collection (IC)
View Information Collection (IC)

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
Form and Instruction 1 Access to Care Attachment 1 -- Access to Care.pdf No   Fillable Fileable
Form and Instruction 2 Additional Health Questions Attachment 2 -- Additional Healthcare Questions.pdf Yes Yes Fillable Fileable
Form and Instruction 3 Assets Attachment 3 -- Assets.pdf Yes Yes Fillable Fileable
Form and Instruction 4 Calendar Section Attachment 4 -- Calendar Section.pdf Yes Yes Fillable Fileable
Form and Instruction 5 Closing Section Attachment 5 -- Closing Section.pdf Yes Yes Fillable Fileable
Form and Instruction 6 Contacting Module Section Attachment 6 -- Contacting Module Section.pdf Yes Yes Fillable Fileable
Form and Instruction 7 Charge Payment Section Attachment 7 -- Charge Payment Section.pdf Yes Yes Fillable Fileable
Form and Instruction 8 Child Preventive Health Section Attachment 8 -- Child Preventive Health Section.pdf Yes Yes Fillable Fileable
Form and Instruction 9 Dental Visit Section Attachment 9 -- Dental Visit Section.pdf Yes Yes Fillable Fileable
Form and Instruction 10 Event Driver Section Attachment 10 -- Event Driver Section.pdf Yes Yes Fillable Fileable
Form and Instruction 11 Event Enumeration Section Attachment 11 -- Event Enumeration Section.pdf Yes Yes Fillable Fileable
Form and Instruction 12 Event Follow-Up Section Attachment 12 -- Event Follow-Up Section.pdf Yes Yes Fillable Fileable
Form and Instruction 13 Employment Section Attachment 13 -- Employment Section.pdf Yes Yes Fillable Fileable
Form and Instruction 14 Employment Driver Section Attachment 14 -- Employment Driver Section.pdf Yes Yes Fillable Fileable
Form and Instruction 15 Emergency Room Section Attachment 15 -- Emergency Room Section.pdf Yes Yes Fillable Fileable
Form and Instruction 16 Event Roster Section Attachment 16 -- Event Roster Section.pdf Yes Yes Fillable Fileable
Form and Instruction 17 Employment Wages Section Attachment 17 -- Employment Wages Section.pdf Yes Yes Fillable Fileable
Form and Instruction 18 Flat Fee Section Attachment 18 -- Flat Fee Section.pdf Yes Yes Fillable Fileable
Form and Instruction 19 Food Security Section Attachment 19 -- Food Security Section.pdf Yes Yes Fillable Fileable
Form and Instruction 20 Global Section Attachment 20 -- Global Section.pdf Yes Yes Fillable Fileable
Form and Instruction 21 Health Status Section Attachment 21 - Health Status Section.pdf Yes Yes Fillable Fileable
Form and Instruction 22 Home Health Section Attachment 22 -- Home Health Section.pdf Yes Yes Fillable Fileable
Form and Instruction 23 Health Insurance Detail Section Attachment 23 -- Health Insurance Detail Section.pdf Yes Yes Fillable Fileable
Form and Instruction 24 Time Period Covered Detail Section Attachment 24 -- Time Period Covered Detail Section.pdf Yes Yes Fillable Fileable
Form and Instruction 25 Hospital Stay Section Attachment 25 -- Hospital Stay Section.pdf Yes Yes Fillable Fileable
Form and Instruction 26 Health Insurance Section Attachment 26 -- Health Insurance Section.pdf Yes Yes Fillable Fileable
Form and Instruction 27 Institutional Care Stay Section Attachment 27 -- Institutional Care Stay Section.pdf Yes Yes Fillable Fileable
Form and Instruction 28 Income Section Attachment 28 -- Income Section.pdf Yes Yes Fillable Fileable
Form and Instruction 29 Institutional Care Section Attachment 29 -- Institutional Care Section.pdf Yes Yes Fillable Fileable
Form and Instruction 30 Medical Visit Section Attachment 30 -- Medical Visit Section.pdf Yes Yes Fillable Fileable
Form and Instruction 31 Old Employment-Private Related Insurance Section Attachment 31 -- Old Empl-Priv Related Ins Section.pdf Yes Yes Fillable Fileable
Form and Instruction 32 Off Path Navigation Section Attachment 32 -- Off Path Navigation Section.pdf Yes Yes Fillable Fileable
Form and Instruction 33 Other Medical Expenses Section Attachment 33 -- Other Medical Expenses Section.pdf Yes Yes Fillable Fileable
Form and Instruction 34 Outpatient Department Section Attachment 34 -- Outpatient Department Section.pdf Yes Yes Fillable Fileable
Form and Instruction 35 Priority Condition Section Attachment 35 -- Priority Condition Enumeration Section.pdf Yes Yes Fillable Fileable
Form and Instruction 36 Prescribed Medicines Section Attachment 36 -- Prescribed Medicines Section.pdf Yes Yes Fillable Fileable
Form and Instruction 37 Provider Probes Section Attachment 37 -- Provider Probes Section.pdf Yes Yes Fillable Fileable
Form and Instruction 38 Old Public Related Insurance Section Attachment 38 -- Old Public Related Insurance Section.pdf Yes Yes Fillable Fileable
Form and Instruction 39 Provider Roster Section Attachment 39 -- Provider Roster Section.pdf Yes Yes Fillable Fileable
Form and Instruction 40 Quality Supplement Section Attachment 40 -- Quality Supplement Section.pdf Yes Yes Fillable Fileable
Form and Instruction 41 Reenumeration A Section Attachment 41 -- Reenumeration A Section.pdf Yes Yes Fillable Fileable
Form and Instruction 42 Reenumeration B Section Attachment 42 -- Reenumeration B Section.pdf Yes Yes Fillable Fileable
Form and Instruction 43 Respondent Forms Section Attachment 43 -- Respondent Forms Section.pdf Yes Yes Fillable Fileable
Form and Instruction 44 Review of Employment Section Attachment 44 -- Review of Employment Section.pdf Yes Yes Fillable Fileable
Form and Instruction 45 Start-Restart Section Attachment 45 -- Start-Restart Section.pdf Yes Yes Fillable Fileable
Form and Instruction 46 Telehealth Section Attachment 46 -- Telehealth Section.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

12,683 0
   
Individuals or Households
 
   100 %

  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 31,708 0 2,333 0 0 29,375
Annual IC Time Burden (Hours) 46,505 0 3,422 0 0 43,083
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
MEPS-HC Show Cards Attachment 47 - MEPS-HC Show Cards.pdf 07/01/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.