Information Collection

Medical Expenditure Panel Survey Household Component and Medical Provider Component (MEPS-HC and MEPS-MPC 2004 and 2005)

IC 37877 under ICR 200609-0935-001 · OMB 0935-0118.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0935-0118 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
02 - RE-B (Beta).pdf MEPS-HC Survey Instrument	IC Document
01 - RE-A (BETA).pdf MEPS-HC Survey Instrument	IC Document
03 - PE (BETA).pdf MEPS-HC Survey Instrument	IC Document
04 - CE (BETA).pdf MEPS-HC Survey Instrument	IC Document
05 - HE (BETA).pdf MEPS-HC Survey Instrument	IC Document
06 - CS (Beta).pdf MEPS-HC Survey Instrument	IC Document
07 - ca (beta).pdf MEPS-HC Survey Instrument	IC Document
08 - PP (BETA).pdf MEPS-HC Survey Instrument	IC Document
09 -EV (BETA).pdf MEPS-HC Survey Instrument	IC Document
10 - PV (BETA).pdf MEPS-HC Survey Instrument	IC Document
11 - ED (BETA).pdf MEPS-HC Survey Instrument	IC Document
12 - HS (BETA).pdf MEPS-HC Survey Instrument	IC Document
13 - er (beta).pdf MEPS-HC Survey Instrument	IC Document
14 - op (beta).pdf MEPS-HC Survey Instrument	IC Document
15 - mv (beta).pdf MEPS-HC Survey Instrument	IC Document
16 - DN (BETA).pdf MEPS-HC Survey Instrument	IC Document
17 - HH (BETA).pdf MEPS-HC Survey Instrument	IC Document
18 - OM (BETA).pdf MEPS-HC Survey Instrument	IC Document
19 - PM (BETA).pdf MEPS-HC Survey Instrument	IC Document
20 - CP (BETA).pdf MEPS-HC Survey Instrument	IC Document
21 - FF (Beta).pdf MEPS-HC Survey Instrument	IC Document
22 - dd (beta).pdf MEPS-HC Survey Instrument	IC Document
23 - CN (BETA).pdf MEPS-HC Survey Instrument	IC Document
24 - PC (BETA).pdf MEPS-HC Survey Instrument	IC Document
25 - AP (BETA).pdf MEPS-HC Survey Instrument	IC Document
26 - AC (Beta).pdf MEPS-HC Survey Instrument	IC Document
27 - EM-O (Beta).pdf MEPS-HC Survey Instrument	IC Document
28 - RJ (Beta).pdf MEPS-HC Survey Instrument	IC Document
29 - EM (Beta).pdf MEPS-HC Survey Instrument	IC Document
30 - EW (Beta).pdf MEPS-HC Survey Instrument	IC Document
31 - HX (Beta).pdf MEPS-HC Survey Instrument	IC Document
32 - HP (Beta).pdf MEPS-HC Survey Instrument	IC Document
33 - HQ (Beta).pdf MEPS-HC Survey Instrument	IC Document
34 - MC (Beta).pdf MEPS-HC Survey Instrument	IC Document
35 - OE (Beta).pdf MEPS-HC Survey Instrument	IC Document
36 - PR (Beta).pdf MEPS-HC Survey Instrument	IC Document
37 - SP (BETA).pdf MEPS-HC Survey Instrument	IC Document
38 - IN (BETA).pdf MEPS-HC Survey Instrument	IC Document
39 - AS (BETA).pdf MEPS-HC Survey Instrument	IC Document
40 - PD (Beta).pdf MEPS-HC Survey Instrument	IC Document
41 - CL (BETA).pdf MEPS-HC Survey Instrument	IC Document
42 - RS (Beta).pdf MEPS-HC Survey Instrument	IC Document
HH Event Book Health Care.pdf MEPS-MPC-Home Health	IC Document
HH Event Book NonHealth Care.pdf MEPS-MPC-Home Health	IC Document
MPC Contact Guide HH.pdf MEPS-MPC-Home Health	IC Document
Carolyn Clancy Letter.pdf MEPS-MPC-Hospital	IC Document
Diagnosis Continue HS.pdf MEPS-MPC-Hospital	IC Document
Global Fee Continue HS .pdf MEPS-MPC-Hospital	IC Document
HS Brochure.pdf MEPS-MPC-Hospital	IC Document
HS Cover Sheet.pdf MEPS-MPC-Hospital	IC Document
HS Fax Return.pdf MEPS-MPC-Hospital	IC Document
HS PatientList.pdf MEPS-MPC-Hospital	IC Document
Med Event Form HS.pdf MEPS-MPC-Hospital	IC Document
MPC Contact Guide HS.pdf MEPS-MPC-Hospital	IC Document
Repeat Visit Continue HS.pdf MEPS-MPC-Hospital	IC Document
SBDFORM.doc MEPS-MPC-Hospital	IC Document
Service Charge Continue HS.pdf MEPS-MPC-Hospital	IC Document
Contact Guide IC.pdf MEPS-MPC-Institutional	IC Document
IC Event Form.pdf MEPS-MPC-Institutional	IC Document
Carolyn Clancy Letter.pdf MEPS-MPC-Office Based	IC Document
Diagnosis Continue OB.pdf MEPS-MPC-Office Based	IC Document
Global Fee Continue OB.pdf MEPS-MPC-Office Based	IC Document
Med Event Form OB.pdf MEPS-MPC-Office Based	IC Document
MPC Contact Guide OB.pdf MEPS-MPC-Office Based	IC Document
OB Brochure.pdf MEPS-MPC-Office Based	IC Document
OB Cover Sheet.pdf MEPS-MPC-Office Based	IC Document
OB Fax Return.pdf MEPS-MPC-Office Based	IC Document
OB PatientList.pdf MEPS-MPC-Office Based	IC Document
Repeat Visit Continue OB.pdf MEPS-MPC-Office Based	IC Document
Service Charge Continue OB.pdf MEPS-MPC-Office Based	IC Document
Carolyn Clancy Letter.pdf MEPS-MPC-Pharmacy	IC Document
Contact Guide Pharm.pdf MEPS-MPC-Pharmacy	IC Document
Pharm Brochure.pdf MEPS-MPC-Pharmacy	IC Document
Pharm Component Data Form.pdf MEPS-MPC-Pharmacy	IC Document
Pharm Cover Sheet.pdf MEPS-MPC-Pharmacy	IC Document
Pharm CustomerList.pdf MEPS-MPC-Pharmacy	IC Document
Pharm Fax Return.pdf MEPS-MPC-Pharmacy	IC Document
Pharm PtRequest.pdf MEPS-MPC-Pharmacy	IC Document
Carolyn Clancy Letter.pdf MEPS-MPC-Sep. Billing Doctors	IC Document
Diagnosis Continue SBD.pdf MEPS-MPC-Sep. Billing Doctors	IC Document
Global Fee Continue SBD.pdf MEPS-MPC-Sep. Billing Doctors	IC Document
Med Event Form SBD.pdf MEPS-MPC-Sep. Billing Doctors	IC Document
MPC Contact Guide SBD.pdf MEPS-MPC-Sep. Billing Doctors	IC Document
MPC Patient Data Form SBD.rtf MEPS-MPC-Sep. Billing Doctors	IC Document
Repeat Visit Continue SBD.pdf MEPS-MPC-Sep. Billing Doctors	IC Document
SBD Brochure.pdf MEPS-MPC-Sep. Billing Doctors	IC Document
SBD Cover Sheet.pdf MEPS-MPC-Sep. Billing Doctors	IC Document
SBD Fax Return.pdf MEPS-MPC-Sep. Billing Doctors	IC Document
SBD PatientList.pdf MEPS-MPC-Sep. Billing Doctors	IC Document
Service Charge Continue SBD.pdf MEPS-MPC-Sep. Billing Doctors	IC Document
Contact Person Call Records.doc MEPS-MPC-Fax Package	IC Document
Doris Lefkowitz Ltr.doc MEPS-MPC-Fax Package	IC Document
MPC DATA FORM.rtf MEPS-MPC-Fax Package	IC Document
MPC List Interviewer Version.rtf MEPS-MPC-Fax Package	IC Document
MPC Patient Data Form SBD.rtf MEPS-MPC-Fax Package	IC Document
Thomas McKenna Ltr.doc MEPS-MPC-Fax Package	IC Document
TOC.doc MEPS-MPC-Table of Contents	IC Document
MEPS Attachments[1].pdf MEPS-HC-Advance Letters & Screener Questionnaires	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Medical Expenditure Panel Survey Household Component and Medical Provider Component (MEPS-HC and MEPS-MPC 2004 and 2005)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 5 CFR 1320.6

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 132,548

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 25 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	132,548	48,848	83,700
Annual IC Time Burden (Hours)	85,184	-164,664	249,848
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
MEPS-HC Survey Instrument	02 - RE-B (Beta).pdf	09/01/2006
MEPS-HC Survey Instrument	01 - RE-A (BETA).pdf	09/01/2006
MEPS-HC Survey Instrument	03 - PE (BETA).pdf	09/01/2006
MEPS-HC Survey Instrument	04 - CE (BETA).pdf	09/01/2006
MEPS-HC Survey Instrument	05 - HE (BETA).pdf	09/01/2006
MEPS-HC Survey Instrument	06 - CS (Beta).pdf	09/01/2006
MEPS-HC Survey Instrument	07 - ca (beta).pdf	09/01/2006
MEPS-HC Survey Instrument	08 - PP (BETA).pdf	09/01/2006
MEPS-HC Survey Instrument	09 -EV (BETA).pdf	09/01/2006
MEPS-HC Survey Instrument	10 - PV (BETA).pdf	09/01/2006
MEPS-HC Survey Instrument	11 - ED (BETA).pdf	09/01/2006
MEPS-HC Survey Instrument	12 - HS (BETA).pdf	09/01/2006
MEPS-HC Survey Instrument	13 - er (beta).pdf	09/01/2006
MEPS-HC Survey Instrument	14 - op (beta).pdf	09/01/2006
MEPS-HC Survey Instrument	15 - mv (beta).pdf	09/01/2006
MEPS-HC Survey Instrument	16 - DN (BETA).pdf	09/01/2006
MEPS-HC Survey Instrument	17 - HH (BETA).pdf	09/01/2006
MEPS-HC Survey Instrument	18 - OM (BETA).pdf	09/01/2006
MEPS-HC Survey Instrument	19 - PM (BETA).pdf	09/01/2006
MEPS-HC Survey Instrument	20 - CP (BETA).pdf	09/01/2006
MEPS-HC Survey Instrument	21 - FF (Beta).pdf	09/01/2006
MEPS-HC Survey Instrument	22 - dd (beta).pdf	09/01/2006
MEPS-HC Survey Instrument	23 - CN (BETA).pdf	09/01/2006
MEPS-HC Survey Instrument	24 - PC (BETA).pdf	09/01/2006
MEPS-HC Survey Instrument	25 - AP (BETA).pdf	09/01/2006
MEPS-HC Survey Instrument	26 - AC (Beta).pdf	09/01/2006
MEPS-HC Survey Instrument	27 - EM-O (Beta).pdf	09/01/2006
MEPS-HC Survey Instrument	28 - RJ (Beta).pdf	09/01/2006
MEPS-HC Survey Instrument	29 - EM (Beta).pdf	09/01/2006
MEPS-HC Survey Instrument	30 - EW (Beta).pdf	09/01/2006
MEPS-HC Survey Instrument	31 - HX (Beta).pdf	09/01/2006
MEPS-HC Survey Instrument	32 - HP (Beta).pdf	09/01/2006
MEPS-HC Survey Instrument	33 - HQ (Beta).pdf	09/01/2006
MEPS-HC Survey Instrument	34 - MC (Beta).pdf	09/01/2006
MEPS-HC Survey Instrument	35 - OE (Beta).pdf	09/01/2006
MEPS-HC Survey Instrument	36 - PR (Beta).pdf	09/01/2006
MEPS-HC Survey Instrument	37 - SP (BETA).pdf	09/01/2006
MEPS-HC Survey Instrument	38 - IN (BETA).pdf	09/01/2006
MEPS-HC Survey Instrument	39 - AS (BETA).pdf	09/01/2006
MEPS-HC Survey Instrument	40 - PD (Beta).pdf	09/01/2006
MEPS-HC Survey Instrument	41 - CL (BETA).pdf	09/01/2006
MEPS-HC Survey Instrument	42 - RS (Beta).pdf	09/01/2006
MEPS-MPC-Home Health	HH Event Book Health Care.pdf	09/01/2006
MEPS-MPC-Home Health	HH Event Book NonHealth Care.pdf	09/01/2006
MEPS-MPC-Home Health	MPC Contact Guide HH.pdf	09/01/2006
MEPS-MPC-Hospital	Carolyn Clancy Letter.pdf	09/01/2006
MEPS-MPC-Hospital	Diagnosis Continue HS.pdf	09/01/2006
MEPS-MPC-Hospital	Global Fee Continue HS .pdf	09/01/2006
MEPS-MPC-Hospital	HS Brochure.pdf	09/01/2006
MEPS-MPC-Hospital	HS Cover Sheet.pdf	09/01/2006
MEPS-MPC-Hospital	HS Fax Return.pdf	09/01/2006
MEPS-MPC-Hospital	HS PatientList.pdf	09/01/2006
MEPS-MPC-Hospital	Med Event Form HS.pdf	09/01/2006
MEPS-MPC-Hospital	MPC Contact Guide HS.pdf	09/01/2006
MEPS-MPC-Hospital	Repeat Visit Continue HS.pdf	09/01/2006
MEPS-MPC-Hospital	SBDFORM.doc	09/01/2006
MEPS-MPC-Hospital	Service Charge Continue HS.pdf	09/01/2006
MEPS-MPC-Institutional	Contact Guide IC.pdf	09/01/2006
MEPS-MPC-Institutional	IC Event Form.pdf	09/01/2006
MEPS-MPC-Office Based	Carolyn Clancy Letter.pdf	09/01/2006
MEPS-MPC-Office Based	Diagnosis Continue OB.pdf	09/01/2006
MEPS-MPC-Office Based	Global Fee Continue OB.pdf	09/01/2006
MEPS-MPC-Office Based	Med Event Form OB.pdf	09/01/2006
MEPS-MPC-Office Based	MPC Contact Guide OB.pdf	09/01/2006
MEPS-MPC-Office Based	OB Brochure.pdf	09/01/2006
MEPS-MPC-Office Based	OB Cover Sheet.pdf	09/01/2006
MEPS-MPC-Office Based	OB Fax Return.pdf	09/01/2006
MEPS-MPC-Office Based	OB PatientList.pdf	09/01/2006
MEPS-MPC-Office Based	Repeat Visit Continue OB.pdf	09/01/2006
MEPS-MPC-Office Based	Service Charge Continue OB.pdf	09/01/2006
MEPS-MPC-Pharmacy	Carolyn Clancy Letter.pdf	09/01/2006
MEPS-MPC-Pharmacy	Contact Guide Pharm.pdf	09/01/2006
MEPS-MPC-Pharmacy	Pharm Brochure.pdf	09/01/2006
MEPS-MPC-Pharmacy	Pharm Component Data Form.pdf	09/01/2006
MEPS-MPC-Pharmacy	Pharm Cover Sheet.pdf	09/01/2006
MEPS-MPC-Pharmacy	Pharm CustomerList.pdf	09/01/2006
MEPS-MPC-Pharmacy	Pharm Fax Return.pdf	09/01/2006
MEPS-MPC-Pharmacy	Pharm PtRequest.pdf	09/01/2006
MEPS-MPC-Sep. Billing Doctors	Carolyn Clancy Letter.pdf	09/01/2006
MEPS-MPC-Sep. Billing Doctors	Diagnosis Continue SBD.pdf	09/01/2006
MEPS-MPC-Sep. Billing Doctors	Global Fee Continue SBD.pdf	09/01/2006
MEPS-MPC-Sep. Billing Doctors	Med Event Form SBD.pdf	09/01/2006
MEPS-MPC-Sep. Billing Doctors	MPC Contact Guide SBD.pdf	09/01/2006
MEPS-MPC-Sep. Billing Doctors	MPC Patient Data Form SBD.rtf	09/01/2006
MEPS-MPC-Sep. Billing Doctors	Repeat Visit Continue SBD.pdf	09/01/2006
MEPS-MPC-Sep. Billing Doctors	SBD Brochure.pdf	09/01/2006
MEPS-MPC-Sep. Billing Doctors	SBD Cover Sheet.pdf	09/01/2006
MEPS-MPC-Sep. Billing Doctors	SBD Fax Return.pdf	09/01/2006
MEPS-MPC-Sep. Billing Doctors	SBD PatientList.pdf	09/01/2006
MEPS-MPC-Sep. Billing Doctors	Service Charge Continue SBD.pdf	09/01/2006
MEPS-MPC-Fax Package	Contact Person Call Records.doc	09/01/2006
MEPS-MPC-Fax Package	Doris Lefkowitz Ltr.doc	09/01/2006
MEPS-MPC-Fax Package	MPC DATA FORM.rtf	09/01/2006
MEPS-MPC-Fax Package	MPC List Interviewer Version.rtf	09/01/2006
MEPS-MPC-Fax Package	MPC Patient Data Form SBD.rtf	09/01/2006
MEPS-MPC-Fax Package	Thomas McKenna Ltr.doc	09/01/2006
MEPS-MPC-Table of Contents	TOC.doc	09/01/2006
MEPS-HC-Advance Letters & Screener Questionnaires	MEPS Attachments[1].pdf	09/01/2006

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.