Medical Expenditure Panel Survey - Insurance Component (MEPS-IC)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Form #3 Plan Questionnaire	Form and Instruction	Modified	Available
Form Form #2 Establishment Questionnaire	Form and Instruction	Modified	Available
Form Form #1 Prescreener Questionnaire	Form and Instruction	Modified	Available
ATTACHMENT O -- Definitions.pdf	Supplementary Document	Uploaded 2015-09-11	Available
ATTACHMENT N - Thank You Letter.pdf	Supplementary Document	Uploaded 2015-09-11	Available
ATTACHMENT M - Call Center Fax Followup Letter, Government Sector.pdf	Supplementary Document	Uploaded 2015-09-11	Repair queued
ATTACHMENT L - Call Center Fax Followup Letter, Private Sector.pdf	Supplementary Document	Uploaded 2015-09-11	Available
ATTACHMENT K - Followup Letter, Government Sector.pdf	Supplementary Document	Uploaded 2015-09-11	Available
ATTACHMENT I - Cover Letter, Government Sector.pdf	Supplementary Document	Uploaded 2015-09-11	Available
ATTACHMENT H - Cover Letter, Private Sector.pdf	Supplementary Document	Uploaded 2015-09-11	Available
ATTACHMENT G Sample Strata 2014.docx	Supplementary Document	Uploaded 2015-09-11	Repair queued
ATTACHMENT F Allocation by State 2016-2017 (2013 numbers).docx	Supplementary Document	Uploaded 2015-09-11	Available
ATTACHMENT E - Confidentiality Form.docx	Supplementary Document	Uploaded 2015-09-11	Available
Attachment D -- 30 Day FRN.pdf	Supplementary Document	Uploaded 2015-09-11	Available
SS Part B -- MEPS-IC 2016 - 2017 8-5-2015.docx	Supporting Statement B	Uploaded 2015-09-11	Available
SS Part A -- MEPS-IC 2016 -2017 8-5-2015.docx	Supporting Statement A	Uploaded 2015-09-11	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
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: 201509-0935-002
Status: Historical Active	Previous ICR Reference No: 201504-0935-001
Agency/Subagency: HHS/AHRQ	Agency Tracking No: 20656
Title: Medical Expenditure Panel Survey - Insurance Component (MEPS-IC)
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/06/2015
	Date Received in OIRA: 09/16/2015
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2018	36 Months From Approved	12/31/2016
Responses	97,805	0	124,404
Time Burden (Hours)	19,883	0	25,151
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:
	80 FR 33267	06/11/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 53154	09/02/2015
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

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

table that charts list 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	97,805	124,404	0	-26,599	0	0
Annual Time Burden (Hours)	19,883	25,151	0	-5,268	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Burden hours are reduced due to a lower expected response rate.

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Annual Cost to Federal Government: $10,581,826

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: 09/16/2015

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