2012 and 2013 Medical Expenditure Panel Survey - Insurance Componenet (MEPS-IC)

Forms and Documents

Document Name	Status
Form Form #3 Plan Questionnaire Form and Instruction	Modified
Form Form #2 Establishment Questionnaire Form and Instruction	Modified
Form Form #1 Prescreener Questionnaire Form and Instruction	Modified
Supporting Statement Part B -- MEPS-IC 2012-2013.docx Supporting Statement B	2011-09-26
ATTACHMENT O -- Definitions.docx Supplementary Document	2011-09-26
ATTACHMENT N -- Thank You Letter.docx Supplementary Document	2011-09-26
ATTACHMENT M -- Call Center Fax Followup Letter Government Sector.docx Supplementary Document	2011-09-26
ATTACHMENT L -- Call Center Fax Followup Letter Private Sector.docx Supplementary Document	2011-09-26
ATTACHMENT K -- Followup Letter Government Sector.docx Supplementary Document	2011-09-26
ATTACHMENT J -- Followup Letter Private Sector.docx Supplementary Document	2011-09-26
ATTACHMENT I -- Cover Letter Government Sector.docx Supplementary Document	2011-09-26
ATTACHMENT H -- Cover Letter Private Sector.docx Supplementary Document	2011-09-26
ATTACHMENT G -- Sample Strata.docx Supplementary Document	2011-09-26
ATTACHMENT F -- Sample Allocation.docx Supplementary Document	2011-09-26
ATTACHMENT E -- Confidentiality Form.docx Supplementary Document	2011-09-26
ATTACHMENT D -- 60 Day Federal Register Notice.pdf Supplementary Document	2011-09-26
Supporting Statement Part A -- MEPS-IC 2012-2013.docx Supporting Statement A	2011-09-26

IC Document Collections

IC ID	Document Title	Status
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: 201110-0935-001
Status: Historical Active	Previous ICR Reference No: 200909-0935-003
Agency/Subagency: HHS/AHRQ	Agency Tracking No:
Title: 2012 and 2013 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 without change	Conclusion Date: 12/12/2011
	Date Received in OIRA: 10/05/2011
Terms of Clearance: This ICR is approved for three years. AHRQ has agreed to consult with OMB as it determines how to modify this questionnaire for 2013 to address the need for additional data to monitor the implementation of the ACA.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2014	36 Months From Approved	01/31/2013
Responses	106,174	0	101,989
Time Burden (Hours)	21,440	0	20,471
Cost Burden (Dollars)	0	0	0

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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.

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Authorizing Statute(s): US Code: 42 USC 299b-2 Name of Law: Health Care Quality Act of 1999
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 38397	06/30/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 57048	09/15/2011
Did the Agency receive public comments on this ICR? No

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

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

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ICR Summary 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	106,174	101,989	0	4,185	0	0
Annual Time Burden (Hours)	21,440	20,471	0	969	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: Total estimated burden hours will go up 4.7 percent from the 2010/2011 clearance estimates. This rise is due to an increase for recent years in the number of respondents to both the establishment and plan questionnaires, despite no change in the overall sample size. A clarification to existing collection procedures also resulted in an increase in the number of completed plan questionnaires.

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Annual Cost to Federal Government: $11,477,000

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]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

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

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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: 10/05/2011

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