Cognitive Testing of the Medical Expenditure Panel Survey (MEPS) Health Insurance Verification Module

Questionnaire and Data Collection Testing, Evaluation, and Research for the Agency for Healthcare Research and Quality

OMB: 0935-0124

IC ID: 226530

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Cognitive Testing of the Medical Expenditure Panel Survey (MEPS) Health Insurance Verification Module
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction B1 Attachment B – Screening Questionnaire Attachment B Screening Questionnaire.docx No   Fillable Fileable
Form and Instruction C1 Attachment C1 - Cognitive Interview Guide and Questionnaire Attachment C__1 Cognitive Interview Guide and Questionnaire.docx No   Fillable Fileable

Health Health Care Services

 

444 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 444 0 444 0 0 0
Annual IC Time Burden (Hours) 77 0 77 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Supporting Statement Part A Supporting Statement Part A -- Cognitive Testing for MEPS.docx 04/24/2017
Supporting Statement Part B Supporting Statement Part B --.docx 04/24/2017
Attachment A – Agency for Healthcare Research and Quality (AHRQ) Mission Attachment A --- Healthcare Research and Quality Act of 1999.pdf 04/24/2017
Attachment C2 – Cognitive Interview Show Cards Attachment C_2 Cognitive Interview Showcards.docx 04/24/2017
Attachment C3 – Cognitive Interview Enumeration Template Attachment C_3 Cognitive Interview Enumeration Template.docx 04/24/2017
Attachment D1 – Thank You (General Population) Attachment D_1 Thank You General Population.docx 04/24/2017
Attachment D2 – Thank You (U.S. Armed Services) Attachment D_2 Thank You US Armed Services.docx 04/24/2017
Attachment D3 – Thank You (Medical Assistance) Attachment D_3 Thank You Medical Assistance.docx 04/24/2017
Attachment D4 – Thank You (Affordable Care Act) Attachment D_4 Thank You Affordable Care Act.docx 04/24/2017
Attachment D5 – Invitation/Recruitment Letter Attachment D_5 Invitation_Recruitment Letter.docx 04/24/2017
Attachment E – Respondent consent form Attachment E Respondent Consent Form.docx 04/24/2017
Attachment F – OMB Cover Letter OMB Cover Letter.docx.doc 04/24/2017
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