MPC Contact Guide/Screening Call

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⚠️ Notice: This information collection may be referencing outdated material.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 MPC Contact Guide/Screening Call Form and Instruction
Form #1 Home Health Contact Guide for Organizations Attachment 29 -- MPC Home Health Contact Guide for Organizations.doc Form and Instruction
Form #2 Office Based Contact Guide Attachment 35 -- MPC Office Based Contact Guide.doc Form and Instruction
Form #3 SBD Contact Guide Attachment 37 -- MPC SBD Contact Guide.doc Form and Instruction
Form #4 Hospital Contact Guide Attachment 41 -- MPC Hospital Contact Guide.doc Form and Instruction
Form #5 Institution Contact Guide Attachment 47 -- MPC Institution Contact Guide.doc Form and Instruction
Form #6 Pharmacy Contact Guide Attachment 49 -- MPC Pharmacy Contact Guide.doc Form and Instruction

Information Collection (IC) Details

IC Title:	MPC Contact Guide/Screening Call	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Form #1	Home Health Contact Guide for Organizations	Attachment 29 -- MPC Home Health Contact Guide for Organizations.doc	Yes	Yes	Fillable Fileable
Form and Instruction	Form #2	Office Based Contact Guide	Attachment 35 -- MPC Office Based Contact Guide.doc	Yes	Yes	Fillable Fileable
Form and Instruction	Form #3	SBD Contact Guide	Attachment 37 -- MPC SBD Contact Guide.doc	Yes	Yes	Fillable Fileable
Form and Instruction	Form #4	Hospital Contact Guide	Attachment 41 -- MPC Hospital Contact Guide.doc	Yes	Yes	Fillable Fileable
Form and Instruction	Form #5	Institution Contact Guide	Attachment 47 -- MPC Institution Contact Guide.doc	Yes	Yes	Fillable Fileable
Form and Instruction	Form #6	Pharmacy Contact Guide	Attachment 49 -- MPC Pharmacy Contact Guide.doc	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 34,000	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
Annual Number of Responses for this IC	34,000	34,000
Annual IC Time Burden (Hours)	1,700	1,700
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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