Diabetes Care SAQ

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

OMB: 0935-0118

IC ID: 191099

Information Collection (IC) Details

View Information Collection (IC)

Diabetes Care SAQ
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction Attachment 22 Attachment 22 -- HC Diabetes SAQ - Proxy Attachment 22 HC Diabetes SAQ Proxy.pdf Yes Yes Paper Only
Form and Instruction Attachment 23 Attachment 23 -- HC Diabetes SAQ - Self Attachment 23 HC Diabetes SAQ Self.pdf Yes Yes Paper Only

Health Health Care Services

 

2,072 0
   
Individuals or Households
 
   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 2,072 0 -273 0 0 2,345
Annual IC Time Burden (Hours) 104 0 -13 0 0 117
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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