Hospitals questionnaire

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

OMB: 0935-0118

IC ID: 191105

Information Collection (IC) Details

View Information Collection (IC)

Hospitals questionnaire
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction Form #1 Hospitals questionnaire Attachment 87 MPC Hospital Event Form.docx No   Fillable Fileable

Health Immunization Management

 

5,077 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 17,820 0 0 0 0 17,820
Annual IC Time Burden (Hours) 2,673 0 0 0 0 2,673
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Attachment 88 – MPC Hospital Provider Authorization Form Package, One Point of Contact for Medical and Patient Account Records Attachment 88 MPC Hospital_MRPA_AF_Packet.doc 09/14/2015
Attachment 89 – MPC Hospital Provider Authorization Form Package, Point of Contact for Medical Records Attachment 89 MPC Hospital_MR_AF_Packet.doc 09/14/2015
Attachment 90 – MPC Hospital Provider Authorization Form Package, Point of Contact for Patient Account Records Attachment 90 MPC Hospital_PA_AF_Packet.doc 09/14/2015
Attachment 91 – MPC Hospital Provider Overflow Patient List Attachment 91 MPC Hospital_Overflow_Patient_List.docx 09/14/2015
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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