Home care for health care providers questionnaire

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0935-0118 can be found here:

Documents and Forms

Document Name Document Type
Form Form #1 Home care for health care providers questionnaire Form and Instruction
Form #1 Home care for health care providers questionnaire Attachment 27 -- MPC Home Care for Health Care Providers Questionnaire.doc Form and Instruction
Attachment 30 -- MPC Home Health Respondent Materials - FAX Version.doc Attachment 30 -- MPC Home Health Respondent Materials - FAX Version IC Document
Attachment 31 -- MPC Home Health Respondent Materials - Phone Version.doc Attachment 31 -- MPC Home Health Respondent Materials - Phone Version IC Document

Information Collection (IC) Details

IC Title:	Home care for health care providers questionnaire	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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 and Instruction	Form #1	Home care for health care providers questionnaire	Attachment 27 -- MPC Home Care for Health Care Providers Questionnaire.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 465	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	3,023	156	2,867
Annual IC Time Burden (Hours)	252	13	239
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment 30 -- MPC Home Health Respondent Materials - FAX Version	Attachment 30 -- MPC Home Health Respondent Materials - FAX Version.doc	09/24/2012
Attachment 31 -- MPC Home Health Respondent Materials - Phone Version	Attachment 31 -- MPC Home Health Respondent Materials - Phone Version.doc	09/24/2012

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