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

Medical Expenditure Panel Survey Household Component and Medical Provider Component (MEPS-HC and MEPS-MPC through 2009)

OMB: 0935-0118

IC ID: 37877

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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:

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 %

	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

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.