2012 and 2013 Medical Expenditure Panel Survey - Insurance Componenet (MEPS-IC)

Forms and Documents

Document Name	Status
Form Form #3 Plan Questionnaire Form and Instruction	Modified
Form Form #2 Establishment Questionnaire Form and Instruction	Modified
Form Form #1 Prescreener Questionnaire Form and Instruction	Modified
Supporting Statement Part B -- MEPS-IC 2012-2013.docx Supporting Statement B	2013-03-21
Attachment S -- AHRQ's Response to Public Comments.docx Supplementary Document	2013-03-21
Attachment R - Public Comment from the SIIA.pdf Supplementary Document	2013-03-21
Attachment Q - Public Comment from the BEA.pdf Supplementary Document	2013-03-21
Attachment P -- Substantive Changes to the Establishment and Plan Questionnaires.docx Supplementary Document	2013-03-21
ATTACHMENT O -- Definitions -- Revised.docx Supplementary Document	2013-03-21
ATTACHMENT N -- Thank You Letter.docx Supplementary Document	2013-03-21
ATTACHMENT M -- Call Center Fax Followup Letter Government Sector.docx Supplementary Document	2013-03-21
ATTACHMENT L -- Call Center Fax Followup Letter Private Sector.docx Supplementary Document	2013-03-21
ATTACHMENT K -- Followup Letter Government Sector.docx Supplementary Document	2013-03-21
ATTACHMENT J -- Followup Letter Private Sector.docx Supplementary Document	2013-03-21
ATTACHMENT I -- Cover Letter Government Sector.docx Supplementary Document	2013-03-21
ATTACHMENT H -- Cover Letter Private Sector.docx Supplementary Document	2013-03-21
ATTACHMENT G -- Sample Strata.docx Supplementary Document	2013-03-21
ATTACHMENT F -- Sample Allocation.docx Supplementary Document	2013-03-21
ATTACHMENT E -- Confidentiality Form.docx Supplementary Document	2013-03-21
Attachment D -- Federal Register Notice.pdf Supplementary Document	2013-03-21
ATTACHMENT C -- Plan Questionnaire -- Currently Approved.pdf Supplementary Document	2013-03-21
ATTACHMENT B -- Establishment Questionnaire -- Currently Approved.pdf Supplementary Document	2013-03-21
Supporting Statement Part A -- MEPS-IC Substantive Change.docx Supporting Statement A	2013-03-21

IC Document Collections

IC ID	Document Title	Status
182461	Plan Questionnaire Form and Instruction	Modified
182460	Establishment Questionnaire Form and Instruction	Modified
182459	Prescreener Questionnaire Form and Instruction	Modified

ICR Details

OMB Control No: 0935-0110	ICR Reference No: 201303-0935-001
Status: Historical Active	Previous ICR Reference No: 201110-0935-001
Agency/Subagency: HHS/AHRQ	Agency Tracking No: 19169
Title: 2012 and 2013 Medical Expenditure Panel Survey - Insurance Componenet (MEPS-IC)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/15/2013
	Date Received in OIRA: 03/25/2013
Terms of Clearance: Prior terms of clearance were met.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2016	12/31/2014	12/31/2014
Responses	106,174	0	106,174
Time Burden (Hours)	21,440	0	21,440
Cost Burden (Dollars)	0	0	0

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Abstract: The current MEPS-IC clearance noted the possibility of making changes to the 2013 MEPS-IC survey in order to address data needs for Patient Protection and Affordable Care Act (PPACA) and other issues. AHRQ solicited input on possible new questions from a working group of over 50 individuals that included multiple representatives from the U.S. Department of Health and Human Services' Assistant Secretary for Planning and Evaluation (ASPE), the Center for Medicare & Medicaid Services' (CMS) Center for Consumer Information and Insurance Oversight, the CMS Office of the Actuary, the National Center for Health Statistics, the President's Council of Economic Advisors, the Office of Management and Budget, the Bureau of Labor Statistics, the Employee Benefits Security Administration, and the Bureau of the Census.

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Authorizing Statute(s): US Code: 42 USC 299b-2 Name of Law: Health Care Quality Act of 1999
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 76043	12/26/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 17210	03/20/2013
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
Prescreener Questionnaire	Form #1	Prescreener Questionnaire
Establishment Questionnaire	Form #2	Attachment B -- Establishment Questionnaire -- Revised
Plan Questionnaire	Form #3	Attachment C -- Plan Questionnaire -- Revised

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	106,174	106,174	0	0	0	0
Annual Time Burden (Hours)	21,440	21,440	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $11,477,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 03/25/2013

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