Prescreener Questionnaire

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

OMB: 0935-0110

IC ID: 182459

Documents and Forms
Information Collection (IC) Details

View Information Collection (IC)

Prescreener 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 Prescreener Questionnaire Attachment A -- Prescreener Questionnaire.docx Yes Yes Fillable Fileable

Health Public Health Monitoring

 

30,041 0
   
Private Sector Businesses or other for-profits, Farms, 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 30,041 0 2,435 0 0 27,606
Annual IC Time Burden (Hours) 2,503 0 18 0 0 2,485
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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