2014 and 2015 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	Unchanged
Supporting Statement Part A -- MEPS-IC Substantive Change (1)_kd.docx Supporting Statement A	2014-06-02
Supporting Statement Part B -- MEPS-IC 9-19-2013.docx Supporting Statement B	2014-04-18
Attachment R -- AHRQs Response to Public Comments 041514.docx Supplementary Document	2014-04-16
Attachment P -- Substantive Changes Overview.docx Supplementary Document	2014-04-14
Attachment O -- Definitions Rev.pdf Supplementary Document	2014-04-14
ATTACHMENT N - Thank You Letter.docx Supplementary Document	2013-09-30
ATTACHMENT M - Call Center Fax Followup Letter, Government Sector.docx Supplementary Document	2013-09-30
ATTACHMENT L - Call Center Fax Followup Letter, Private Sector.docx Supplementary Document	2013-09-30
ATTACHMENT K - Followup Letter, Government Sector.docx Supplementary Document	2013-09-30
ATTACHMENT J - Followup Letter, Private Sector.docx Supplementary Document	2013-09-30
ATTACHMENT I - Cover Letter, Government Sector.docx Supplementary Document	2013-09-30
ATTACHMENT H - Cover Letter, Private Sector.docx Supplementary Document	2013-09-30
ATTACHMENT G Sample Strata.docx Supplementary Document	2013-09-30
ATTACHMENT F Allocation by State.docx Supplementary Document	2013-09-30
ATTACHMENT E - Confidentiality Form.docx Supplementary Document	2013-09-30
ATTACHMENT D - 60 Day Federal Register Notice.pdf Supplementary Document	2013-09-30

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	Unchanged

ICR Details

OMB Control No: 0935-0110	ICR Reference No: 201404-0935-001
Status: Historical Active	Previous ICR Reference No: 201310-0935-001
Agency/Subagency: HHS/AHRQ	Agency Tracking No: 20656
Title: 2014 and 2015 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 with change	Conclusion Date: 06/03/2014
	Date Received in OIRA: 04/22/2014
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2016	11/30/2016	11/30/2016
Responses	113,429	0	113,429
Time Burden (Hours)	23,150	0	23,150
Cost Burden (Dollars)	0	0	0

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Abstract: Employer-sponsored health insurance is the source of coverage for 78 million current and former workers, plus many of their family members, and is a cornerstone of the U.S. health care system. The Medical Expenditure Panel Survey - Insurance Component (MEPS-IC) measures the extent, cost, and coverage of employer-sponsored health insurance on an annual basis. These statistics are produced at the National, State, and sub-State (metropolitan area) level for private industry. Statistics are also produced for State and Local governments.

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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:
	79 FR 1868	01/10/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 18030	03/31/2014
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	Establishment Questionnaire
Plan Questionnaire	Form #3	Plan Questionnaire

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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	113,429	113,429	0	0	0	0
Annual Time Burden (Hours)	23,150	23,150	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: $10,400,000

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]? Yes

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: 04/22/2014

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