View Information Collection (IC)

View Information Collection (IC)

MEPS-HC Core Interview
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction Attachment 29 Attachment 29 –HC Access to Care Section Attachment 29 HC Access to Care Section.pdf Yes Yes Fillable Fileable
Form and Instruction Attachment 30 Attachment 30 – HC Condition Enumeration Section Attachment 30 HC Event Enumeration Section.pdf Yes Yes Fillable Fileable
Form and Instruction Attachment 31 Attachment 31 – Attachment 31 HC Assets Section. Attachment 31 HC Assets Section.pdf Yes Yes Fillable Fileable
Form and Instruction Attachment 32 Attachment 32 – Attachment 32 HC Calendar Section Attachment 32 HC Calendar Section.pdf Yes Yes Fillable Fileable
Form and Instruction Attachment 33 Attachment 33 Additional healthcare Section Attachment 33 Additional healthcare Section.pdf Yes Yes Fillable Fileable
Form and Instruction Attachment 34 Attachment 34 HC Closing Section Attachment 34 HC Closing Section.pdf Yes Yes Fillable Fileable
Form and Instruction Attachment 35 Attachment 35 HC Start_Restart Attachment 35 HC Start_Restart Section.pdf Yes Yes Fillable Fileable
Form and Instruction Attachment 36 Attachment 36 HC Charge Payment Section Attachment 36 HC Charge Payment Section.pdf Yes Yes Fillable Fileable
Form and Instruction Attachment 37 Attachment 37 HC Flat Fee Section Attachment 37 HC Flat Fee Section.pdf Yes Yes Fillable Fileable
Form and Instruction Attachment 38 Attachment 38 – HC Child Preventive Health Supplement Section Attachment 38 Child Preventive Health Supplement Section.pdf Yes Yes Fillable Fileable
Form and Instruction Attachment 39 Attachment 39 – HC Institutional Care Section Attachment 39 HC Institutional Care Section.pdf Yes Yes Fillable Fileable
Form and Instruction Attachment 40 Attachment 40 – HC Dental Care Section Attachment 40 HC Dental Care Section.pdf Yes Yes Fillable Fileable
Form and Instruction Attachment 41 Attachment 41 – HC Event Driver Section Attachment 41 HC Event Driver Section.pdf Yes Yes Fillable Fileable
Form and Instruction Attachment 42 Attachment 42 – HC Employment (EM) Section Attachment 42 HC Employment (EM) Section.pdf Yes Yes Fillable Fileable
Form and Instruction Attachment 43 Attachment 43 – HC Review of Employment Information (RJ) Section Attachment 43 HC Review of Employment Information (RJ) Section.pdf Yes Yes Fillable Fileable
Form and Instruction Attachment 44 Attachment 44 – HC Employment Driver (OE) Section Attachment 44 HC Employment Driver (OE) Section.pdf Yes Yes Fillable Fileable
Form and Instruction Attachment 45 Attachment 45 – HC Employment Wage (EW) Section Attachment 45 Employment Wage (EW) Section.pdf Yes Yes Fillable Fileable
Form and Instruction Attachment 46 Attachment 46 – HC Emergency Room Section Attachment 46 Emergency Room Section.pdf Yes Yes Fillable Fileable
Form and Instruction Attachment 47 Attachment 47 Event Roster Section Attachment 47 Event Roster Section.pdf Yes Yes Fillable Fileable
Form and Instruction Attachment 48 Attachment 48 Health Status Section Attachment 48 Health Status Section.pdf Yes Yes Fillable Fileable
Form and Instruction Attachment 49 Attachment 49 HC Help Text Attachment 49 HC Help Text.pdf Yes Yes Fillable Fileable
Form and Instruction Attachment 50 Attachment 50 Home Health Section Attachment 50 Home Health Section.pdf Yes Yes Fillable Fileable
Form and Instruction Attachment 51 Attachment 51 Health Insurance (HX) Section Attachment 51 Health Insurance (HX) Section.pdf Yes Yes Fillable Fileable
Form and Instruction Attachment 52 HC Attachment 52 HC Private Health Insurance Detail (HP) Section Attachment 52 HC Private Health Insurance Detail (HP) Section.pdf Yes Yes Fillable Fileable
Form and Instruction Attachment 53 Attachment 53 HC Time Covered Detail (HQ) Section Attachment 53 HC Time Covered Detail (HQ) Section.pdf Yes Yes Fillable Fileable
Form and Instruction Attachment 54 Attachment 54 HC Managed Care (MC) Section Attachment 54 HC Managed Care (MC) Section.pdf Yes Yes Fillable Fileable
Form and Instruction Attachment 55 Attachment 55 HC Old Employment Health Insurance (OE) Section Attachment 55 HC Old Employment Health Insurance (OE) Section.pdf Yes Yes Fillable Fileable
Form and Instruction Attachment 56 Attachment 56 HC Old Public Related Insurance (PR) Section Attachment 56 HC Old Public Related Insurance (PR) Section.pdf Yes Yes Fillable Fileable
Form and Instruction Attachment 57 Attachment 57 HC Hospital Stay Section Attachment 57 HC Hospital Stay Section.pdf Yes Yes Fillable Fileable
Form and Instruction Attachment 58 Attachment 58 HC Income Section Attachment 58 HC Income Section.pdf Yes Yes Fillable Fileable
Form and Instruction Attachment 59 Attachment 59 HC Medical Provider Section Attachment 59 HC Medical Provider Section.pdf Yes Yes Fillable Fileable
Form and Instruction Attachment 60 Attachment 60 HC Other Medical Expense Section Attachment 60 HC Other Medical Expense Section.pdf Yes Yes Fillable Fileable
Form and Instruction Attachment 61 Attachment 61 HC Outpatient Department Section Attachment 61 HC Outpatient Department Section.pdf Yes Yes Fillable Fileable
Form and Instruction Attachment 62 Attachment 62 HC Quality Supplement Section Attachment 62 HC Quality Supplement Section.pdf Yes Yes Fillable Fileable
Form and Instruction Attachment 63 Attachment 63 HC Respondent Forms Section Attachment 63 HC Respondent Forms Section.pdf Yes Yes Fillable Fileable
Form and Instruction Attachment 64 Attachment 64 HC Priority Conditions Enumeration Section Attachment 64 HC Priority Conditions Enumeration Section.pdf Yes Yes Fillable Fileable
Form and Instruction Attachment 65 Attachment 65 HC Prescribed Medicines Section Attachment 65 HC Prescribed Medicines Section.pdf Yes Yes Fillable Fileable
Form and Instruction Attachment 66 Attachment 66 HC Provider Probes Section Attachment 66 HC Provider Probes Section.pdf Yes Yes Fillable Fileable
Form and Instruction Attachment 67 Attachment 67 HC Provider Roster Section Attachment 67 HC Provider Roster Section.pdf Yes Yes Fillable Fileable
Form and Instruction Attachment 68 Attachment 68 HC Reenumeration Subsection Attachment 68 HC Reenumeration Subsection A.pdf Yes Yes Fillable Fileable
Form and Instruction Attachment 69 Attachment 69 HC Reenumeration Subsection B Attachment 69 HC Reenumeration Subsection B.pdf Yes Yes Fillable Fileable
Form and Instruction Attachment 70 Attachment 70 HC RU Information Screener Attachment 70 HC RU Information Screener.docx Yes Yes Fillable Fileable
Form and Instruction Attachment 71 Attachment 71 HC Event Follow Up Section Attachment 71 HC Event Follow Up Section.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

13,338 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 33,345 0 0 0 0 33,345
Annual IC Time Burden (Hours) 51,129 0 0 0 0 51,129
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Attachment 2 - HC Why is Participation in MEPS so Important 02-HC Why is Participation in MEPS so Important.pdf 09/10/2015
Attachment 4 -- HC Policy Impact Award Attachment 4 -- HC Policy Impact Award.doc 09/24/2012
Attachment 3 -- HC MEPS A Survey of Health Care Use and Spending 03-HC MEPS A Survey of Health Care Use and Spending.pdf 09/10/2015
Attachment 8 – HC Important Information About Your Participation in MEPS 08-HC Important Information About Your Participatio in MEPS.doc 09/11/2015
Attachment 9 – HC MEPS Data Example & FAQs 09-HC MEPS Data Example&FAQs.docx 09/11/2015
Attachment 10 – HC Respondent Letters, Postcards and Notes 10-HC Respondent Letters, Postcards and Notes.docx 09/11/2015
Attachment 11 – HC MEPS FAQs Brochure 11-HC MEPS FAQs Brochure.docx 09/11/2015
Attachment 12 – HC MEPS Monthly Planner 12-HC MEPS Monthly Planner.pdf 09/11/2015
Attachment 13 – HC MEPS Record Keeper 13-HC MEPS Record Keeper.pdf 09/11/2015
Attachment 14 – HC Showcards 14-HC Showcards.docx 09/11/2015
Attachment 16 – HC Certificate of Appreciation 16-HC Certificate of Appreciation.pdf 09/11/2015
Attachment 17 – HC Who Uses MEPS Data 17-HC Who Uses MEPS Data.docx 09/11/2015
Attachment 24 – HC MEPS Tip Sheet 24-MEPS Tip Sheet.docx 09/11/2015
Attachment 25 – HC Tips for Making Your MEPS Interview Easier 25-HC Tips for Making Your MEPS Interview Easier.docx 09/11/2015
Attachment 5 – HC About the MEPS-MPC Authorization Form 05-HC About the MEPS-MPC Authorization Form.docx 09/10/2015
Attachment 6 – HC Data protection is word ONE with MEPS 06-HC Data protection is word ONE with MEPS.doc 09/11/2015
Attachment 15 – HC Validation Letter 15-HC Validation Letter.doc 09/11/2015
Attachment 4 – HC What MEPS tells us about…Charts 04-HC What MEPS tells us about...Charts.docx 09/10/2015
Attachment 7 – HC Respondent Recruitment Video Attachment 7 HC Respondent Recruitment Video Link.msg 09/11/2015
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.