Establishment Questionnaire

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

OMB: 0935-0110

IC ID: 182460

Documents and Forms
Information Collection (IC) Details

View Information Collection (IC)

Establishment 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 #2 Establishment Questionnaire Attachment B -- Establishment Questionnaire.pdf Yes Yes Fillable Fileable

Health Public Health Monitoring

 

25,914 0
   
Private Sector Farms, Not-for-profit institutions, Businesses or other for-profits
 
   50 %

  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 25,914 0 2,100 0 0 23,814
Annual IC Time Burden (Hours) 9,934 0 885 0 0 9,049
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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