Attachment S Noa 2-3-2005

NOTICE OF OFFICE OF MANAGEMENT AND BUDGET ACTION
Date 02/03/2005
Department of Health and Human Services
Agency for Healthcare Research and Quality
FOR CERTIFYING OFFICIAL:
FOR CLEARANCE OFFICER:
In accordance with the Paperwork Reduction Act, OMB has taken action on your request received
10/20/2004
ACTION REQUESTED: Revision of a currently approved collection
TYPE OF REVIEW REQUESTED: Regular
ICR REFERENCE NUMBER: 200410-0935-002
TITLE: 2004 - 2006 Medical Expenditure Panel Survey - Insurance Componenet (MEPS-IC)
LIST OF INFORMATION COLLECTIONS: See next page
OMB ACTION: Approved without change
OMB CONTROL NUMBER: 0935-0110
The agency is required to display the OMB Control Number and inform respondents of its legal significance in
accordance with 5 CFR 1320.5(b).
EXPIRATION DATE: 02/29/2008

DISCONTINUE DATE:

BURDEN:

RESPONSES

HOURS

COSTS

Previous

35,131

21,191

0

New

36,264

20,922

0

0

0

0

1,133

-269

0

Change due to Agency Adjustment

0

0

0

Change Due to Potential Violation of the PRA

0

0

0

Difference
Change due to New Statute
Change due to Agency Discretion

TERMS OF CLEARANCE: Approved consistent with the following terms of clearance: HHS shall continue
their coordination efforts with DOL on their National Compensation Survey. HHS will report on the status of
those coordination efforts and any changes made to the survey based on those coordination efforts in the next
submission.
OMB Authorizing Official:

Donald R. Arbuckle
Deputy Administrator,
Office of Information and Regulatory Affairs

List of ICs
IC Title
2004 - 2006 Medical
Expenditure Panel Survey
- Insurance Componenet
(MEPS-IC)

Form No.

Form Name

CFR Citation