View Information Collection Request (ICR) Package
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View Information Collection (IC) List
View Supporting Statement and Other Documents
Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
0935-0118
ICR Reference No:
201412-0935-002
Status:
Historical Active
Previous ICR Reference No:
201209-0935-001
Agency/Subagency:
HHS/AHRQ
Agency Tracking No:
Title:
Medical Expenditure Panel Survey Household Component and Medical Provider Component (MEPS-HC and MEPS-MPC through 2009)
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved with change
Conclusion Date:
02/18/2015
Retrieve Notice of Action (NOA)
Date Received in OIRA:
12/23/2014
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
12/31/2015
12/31/2015
12/31/2015
Responses
505,956
0
505,956
Time Burden (Hours)
82,822
0
82,822
Cost Burden (Dollars)
0
0
0
Abstract:
The MEPS includes the collection of data from household and medical providers to provide nationally representative unbiased estimates of health care use and expenditures for the U.S. civilian noninstitutionalized population.
Authorizing Statute(s):
US Code:
42 USC 299
Name of Law: Agency for Healthcare Research and Quality Act of 1999
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
79 FR 51565
08/29/2014
30-day Notice:
Federal Register Citation:
Citation Date:
79 FR 70188
11/25/2014
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
14
IC Title
Form No.
Form Name
Adult SAQ
Form #1
Attachment 21 -- HC Adult SAQ
Authorization form for the MEPS-MPC Pharmacy Survey
Form #1
Authorization form for the MEPS-MPC Pharmacy Survey
Authorization form for the MEPS-MPC Provider Survey
Form #1
Authorization Form for the MEPS-MPC - Provider
Diabetes Care SAQ
Form #1, Form #2
Attachment 22 -- HC Diabetes SAQ - Proxy
,
Attachment 23 -- HC Diabetes SAQ - Self
Home care for health care providers questionnaire
Form #1
Home care for health care providers questionnaire
Home care for non health care providers questionnaire
Form #1
Home care for non health care providers questionnaire
Hospitals questionnaire
Form #1
Hospitals questionnaire
Institutions (non-hospital) questionnaire
Form #1
Institutions (non-hospital) questionnaire
MEPS-HC Core Interview
1
Attachment 1 -- MEPS-HC Section Summary and Changes
MEPS-HC Validation Interview
Form #1
Validation Interview Form
MPC Contact Guide/Screening Call
Form #1, Form #2, Form #3, Form #4, Form #5, Form #6
Home Health Contact Guide for Organizations
,
Office Based Contact Guide
,
SBD Contact Guide
,
Hospital Contact Guide
,
Institution Contact Guide
,
Pharmacy Contact Guide
Office based providers questionnaire
Form #1
Office based providers questionnaire
Pharmacies questionnaire
Form #1
Pharmacies questionnaire
Separately billing doctors questionnaire
Form #1
Separately billing doctors questionnaire
ICR Summary of Burden
Total Approved
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in Estimate
Change Due to Potential Violation of the PRA
Annual Number of Responses
505,956
505,956
0
0
0
0
Annual Time Burden (Hours)
82,822
82,822
0
0
0
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
No
Burden Increase Due to:
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
Annual Cost to Federal Government:
$51,401,596
Does this IC contain surveys, censuses, or employ statistical methods?
Yes
Part B of Supporting Statement
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
No
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
No
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
No
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
Doris Lefkowitz 3014271477
Common Form ICR:
No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date:
12/23/2014
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