2010 and 2011 Medical Expenditure Panel Survey - Insurance Componenet (MEPS-IC)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Form #3 Plan Questionnaire	Form and Instruction	Modified	Available
Form Form #2 Establishment Questionnaire	Form and Instruction	Modified	Available
Form Form #1 Prescreener Questionnaire	Form and Instruction	Modified	Available
OMB Memo.doc	Supplementary Document	Uploaded 2010-01-15	Available
Supporting Statement Part B -- MEPS IC 2010 - 2011 1-15-2010.doc	Supporting Statement B	Uploaded 2010-01-15	Available
ATTACHMENT Q -- Public Comment & Response.doc	Supplementary Document	Uploaded 2009-09-03	Available
ATTACHMENT M -- Definitions.doc	Supplementary Document	Uploaded 2009-09-02	Available
ATTACHMENT L -- Thank You Letter.doc	Supplementary Document	Uploaded 2009-09-02	Available
ATTACHMENT K -- Call Center Fax Followup Letter Government Sector.doc	Supplementary Document	Uploaded 2009-09-02	Available
ATTACHMENT J -- Call Center Fax Followup Letter Private Sector.doc	Supplementary Document	Uploaded 2009-09-02	Available
ATTACHMENT I -- Followup Letter Government Sector.doc	Supplementary Document	Uploaded 2009-09-02	Available
ATTACHMENT H -- Followup Letter Private Sector.doc	Supplementary Document	Uploaded 2009-09-02	Repair queued
ATTACHMENT G -- Cover Letter Government Sector.doc	Supplementary Document	Uploaded 2009-09-02	Available
ATTACHMENT F -- Cover Letter Private Sector.doc	Supplementary Document	Uploaded 2009-09-02	Available
ATTACHMENT E -- Sample Strata.doc	Supplementary Document	Uploaded 2009-09-02	Available
ATTACHMENT D -- Sample Allocation.doc	Supplementary Document	Uploaded 2009-09-02	Repair queued
ATTACHMENT C -- Confidentiality Form.doc	Supplementary Document	Uploaded 2009-09-02	Available
ATTACHMENT B -- 60 Day FR Notice.pdf	Supplementary Document	Uploaded 2009-09-02	Available
Attachment A -- Healthcare Research and Quality Act of 1999.pdf	Supplementary Document	Uploaded 2009-09-02	Available
Supporting Statement Part A -- MEPS IC 2010 - 2011 9-1-2009.doc	Supporting Statement A	Uploaded 2009-09-02	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
182461	Plan Questionnaire	Form and Instruction	Modified
182460	Establishment Questionnaire	Form and Instruction	Modified
182459	Prescreener Questionnaire	Form and Instruction	Modified

ICR Details

OMB Control No: 0935-0110	ICR Reference No: 200909-0935-003
Status: Historical Active	Previous ICR Reference No: 200710-0935-001
Agency/Subagency: HHS/AHRQ	Agency Tracking No:
Title: 2010 and 2011 Medical Expenditure Panel Survey - Insurance Componenet (MEPS-IC)
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 01/26/2010
	Date Received in OIRA: 09/11/2009
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2013	05/31/2012	05/31/2010
Responses	101,989	0	93,047
Time Burden (Hours)	20,471	0	19,032
Cost Burden (Dollars)	0	0	0

---

Abstract: Data is used by the Agency, other Federal, State and local agencies and the private sector to monitor and perform research on the topic of employer sponsor health insurance. Data from this survey supports calculation of Gross domestic product by the Bureau of Economic Analysis. Respondents are all public and private sector employers in the United States.

---

Authorizing Statute(s): US Code: 42 USC 299b-2 Name of Law: Health Care 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:
	74 FR 28504	06/16/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 42077	08/20/2009
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
Prescreener Questionnaire	Form #1	Prescreener Questionnaire
Establishment Questionnaire	Form #2	Establishment Questionnaire
Plan Questionnaire	Form #3	Plan Questionnaire

---

ICR Summary of Burden

table that charts list 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	101,989	93,047	0	8,942	0	0
Annual Time Burden (Hours)	20,471	19,032	0	1,439	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Overall, annual estimated burden hours will increase by 7.6 percent, compared to the 2008-2009 clearance. A slight decrease in burden due to fewer respondents for all forms will be offset by an increase in the number of expected plan forms to be completed per respondent (from an average 1.6 to 2.1), based on results from prior years.

---

Annual Cost to Federal Government: $10,329,000

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]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

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: 09/11/2009

---