Home care for non health care providers questionnaire

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

OMB: 0935-0118

IC ID: 191102

Information Collection (IC) Details

View Information Collection (IC)

Home care for non health care providers questionnaire
 
No Modified
 
Voluntary
 

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 non health care providers questionnaire Attachment 78 MPC Home Care NonHealth Event Form.docx Yes Yes Fillable Fileable

Health Consumer Health and Safety

 

25 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   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 25 0 -206 0 0 231
Annual IC Time Burden (Hours) 5 0 -14 0 0 19
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Attachment 75 – MPC Home Care Provider Authorization Form Package, Phone Data Collection Anticipated Attachment 75 MPC HomeHealth_Phone_AF_Packet.doc 09/11/2015
Attachment 76 – MPC Home Care Provider Authorization Form Package, Records to be Provided via Fax Anticipated Attachment 76 MPC HomeHealth_Fax_AF_Packet.doc 09/11/2015
Attachment 77 – MPC Home Care Provider Overflow Patient List Attachment 77 MPC HomeHealth_Overflow_Patient_List.docx 09/11/2015
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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