Diabetes Care SAQ

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

OMB: 0935-0118

IC ID: 191099

Information Collection (IC) Details

View Information Collection (IC)

Diabetes Care SAQ
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction Form #2 Diabetes care SAQ -- Self Attachment 72 -- HC Diabetes SAQ - Self.doc Yes Yes Paper Only
Form and Instruction Form #3 Diabetes care SAQ -- Proxy Attachment 71 -- HC Diabetes SAQ - Proxy.doc Yes Yes Paper Only

Health Consumer Health and Safety

 

1,800 0
   
Individuals or Households
 
   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 1,800 0 0 0 0 1,800
Annual IC Time Burden (Hours) 90 0 0 0 0 90
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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