Attachment 3 -- Female Adult - SAQ

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0935-0118 can be found here:

Documents and Forms

Document Name Document Type
Form 3 (02092018) Attachment 3 -- Female Adult - SAQ Form and Instruction
3 (02092018) Attachment 3 (02092018) MEPS SAQ 2018 Female v2 (39568 - Draft, Traditional).pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Attachment 3 -- Female Adult - SAQ	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	3 (02092018)	Attachment 3 (02092018)	MEPS SAQ 2018 Female v2 (39568 - Draft, Traditional).pdf		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 14,692	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	14,692	14,692
Annual IC Time Burden (Hours)	1,714	1,714
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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