Permission Forms for the MEPS-MPC

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

OMB: 0935-0118

IC ID: 191100

Information Collection (IC) Details

View Information Collection (IC)

Permission Forms for the MEPS-MPC
 
No Removed
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction Form #4 Pharmacy Form Attachment 73 -- HC Permission Form for the MEPS-MPC -- Pharmacy.doc Yes Yes Paper Only
Form and Instruction Form #5 Provider Form Attachment 74 -- HC Permission Form for the MEPS-MPC -- Provider.doc Yes Yes Paper Only

Health Consumer Health and Safety

 

15,000 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 0 0 -78,000 0 0 78,000
Annual IC Time Burden (Hours) 0 0 -3,900 0 0 3,900
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Attachment 22 -- HC MEPS-MPC Permission Form FAQs Attachment 22 -- HC MEPS-MPC Permission Form FAQs.doc 08/21/2009
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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