Home care for health care providers questionnaire

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

OMB: 0935-0118

IC ID: 191101

Information Collection (IC) Details

View Information Collection (IC)

Home care for health care providers questionnaire
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction Form #6 Home care for health care providers questionnaire Attachment 75 -- MPC Home Care for Health Care Providers Questionnaire.doc Yes Yes Fillable Fileable

Health Consumer Health and Safety

 

441 0
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 2,867 0 2,867 0 0 0
Annual IC Time Burden (Hours) 239 0 239 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Attachment 79 -- MPC Home Health FAQs BROCHURE Attachment 79 -- MPC Home Health FAQs BROCHURE.doc 08/24/2009
Attachment 77 -- MPC Home Health Contact Guide for Organizations Attachment 77 -- MPC Home Health Contact Guide for Organizations.doc 08/24/2009
Attachment 78 -- MPC Home Health Cover Letter Attachment 78 -- MPC Home Health Cover Letter.doc 08/24/2009
Attachment 80 -- MPC Home Health Fax Cover Sheet Attachment 80 -- MPC Home Health Fax Cover Sheet.doc 08/24/2009
Attachment 81 -- MPC Home Health Fax or Mail Return Form Attachment 81 -- MPC Home Health Fax or Mail Return Form.doc 08/24/2009
Attachment 82 -- MPC Home Health Instructions & Client Check List - FAX Version Attachment 82 -- MPC Home Health Instructions & Client Check List - FAX Version.doc 08/24/2009
Attachment 83 -- MPC Home Health Instructions & Client Check List - Phone Version Attachment 83 -- MPC Home Health Instructions & Client Check List - Phone Version.doc 08/24/2009
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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