Office based providers questionnaire

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

OMB: 0935-0118

IC ID: 191103

Information Collection (IC) Details

View Information Collection (IC)

Office based 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 #8 Office based providers questionnaire Attachment 84 -- MPC Office Based Providers Questionnaire.doc Yes Yes Fillable Fileable

Health Consumer Health and Safety

 

13,665 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   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 79,257 0 79,257 0 0 0
Annual IC Time Burden (Hours) 6,605 0 6,605 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Attachment 85 -- MPC Office Based Cover Letter Attachment 85 -- MPC Office Based Cover Letter.doc 08/24/2009
Attachment 86 -- MPC Office Based FAQs Brochure Attachment 86 -- MPC Office Based FAQs Brochure.doc 08/24/2009
Attachment 87 -- MPC Office Based Fax Cover Sheet Attachment 87 -- MPC Office Based Fax Cover Sheet.doc 08/24/2009
Attachment 88 -- MPC Office Based Fax or Mail Return Form Attachment 88 -- MPC Office Based Fax or Mail Return Form.doc 08/24/2009
Attachment 89 -- MPC Office Based Instructions & Patient List - FAX Version Attachment 89 -- MPC Office Based Instructions & Patient List - FAX Version.doc 08/24/2009
Attachment 90 -- MPC Office Based Instructions & Patient List - Phone Version Attachment 90 -- MPC Office Based Instructions & Patient List - Phone Version.doc 08/24/2009
Attachment 91 -- MPC Office Based Contact Guide Attachment 91 -- MPC Office Based Contact Guide.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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