Pretest of the Medical Expenditure Panel Survey

Questionnaire and Data Collection Testing, Evaluation, and Research for the Agency for Healthcare Research and Quality

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0935-0124 can be found here:

Documents and Forms

Document Name Document Type
Form Form #1 Pretest of the Medical Expenditure Panel Survey Form
Form #1 Quick Response Survey Questionnaire Attachment A -- MEPS Quick Response Survey Questionnaire.docx Form
Attachment B -- Advance Letter.docx Attachment B -- Advance Letter IC Document
Attachment C -- Followup Letter.docx Attachment C -- Followup Letter IC Document
Supporting Statement A -- Pretest of the MEPS Quick Response Survey 1-12-2012 Final.doc Supporting Statement A -- Pretest of the MEPS Quick Response Survey 1-12-2012 Final IC Document
Supporting Statement B -- Pretest of the MEPS Quick Response Survey 1-12-2012 final.doc Supporting Statement B -- Pretest of the MEPS Quick Response Survey 1-12-2012 final IC Document

Information Collection (IC) Details

IC Title:	Pretest of the Medical Expenditure Panel Survey	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	Form #1	Quick Response Survey Questionnaire	Attachment A -- MEPS Quick Response Survey Questionnaire.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 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	1,500	0	0	0	0	0
Annual IC Time Burden (Hours)	250	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment B -- Advance Letter	Attachment B -- Advance Letter.docx	01/13/2012
Attachment C -- Followup Letter	Attachment C -- Followup Letter.docx	01/13/2012
Supporting Statement A -- Pretest of the MEPS Quick Response Survey 1-12-2012 Final	Supporting Statement A -- Pretest of the MEPS Quick Response Survey 1-12-2012 Final.doc	01/13/2012
Supporting Statement B -- Pretest of the MEPS Quick Response Survey 1-12-2012 final	Supporting Statement B -- Pretest of the MEPS Quick Response Survey 1-12-2012 final.doc	01/13/2012

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.