Hospitals questionnaire

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

OMB: 0935-0118

IC ID: 191105

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Hospitals questionnaire
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction Form #10 Hospitals questionnaire Attachment 99 -- MPC Hospital Questionnaire.doc Yes Yes Fillable Fileable

Health Consumer Health and Safety

 

5,402 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 35,113 0 0 0 0 35,113
Annual IC Time Burden (Hours) 2,926 0 0 0 0 2,926
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Attachment 100 -- MPC Hospital Contact Guide Attachment 100 -- MPC Hospital Contact Guide.doc 08/24/2009
Attachment 101 -- MPC Hospital Cover Letter Attachment 101 -- MPC Hospital Cover Letter.doc 08/24/2009
Attachment 102 -- MPC Hospital FAQs BROCHURE Attachment 102 -- MPC Hospital FAQs BROCHURE.DOC 08/24/2009
Attachment 103 -- MPC Hospital Fax Cover Sheet Attachment 103 -- MPC Hospital Fax Cover Sheet.doc 08/24/2009
Attachment 104 -- MPC Hospital Fax or Mail Return Form Attachment 104 -- MPC Hospital Fax or Mail Return Form.doc 08/24/2009
Attachment 105 -- MPC Hospital Instructions & Patient Accounts Check List - FAX Version Attachment 105 -- MPC Hospital Instructions & Patient Accounts Check List - FAX Version.doc 08/24/2009
Attachment 106 -- MPC Hospital Instructions & Patient Accounts Check List - Phone Version Attachment 106 -- MPC Hospital Instructions & Patient Accounts Check List - Phone Version.doc 08/24/2009
Attachment 107 -- MPC Hospital Instructions & Patient Records Check List - Fax Version Attachment 107 -- MPC Hospital Instructions & Patient Records Check List - Fax Version.doc 08/24/2009
Attachment 108 -- MPC Hospital Instructions & Patient Records Check List - Phone Version Attachment 108 -- MPC Hospital Instructions & Patient Records 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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