MPC Contact Guide/Screening Call

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⚠️ Notice: This information collection may be referencing outdated material.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 Attachment 72 MPC Contact Guide/Screening Call Form and Instruction
Attachment 72 Attachment 72 – MPC Hospital Contact Guide Attachment 72 – MPC Hospital Contact Guide.docx Form and Instruction
Attachment 73 Attachment 73 – MPC Office-Based Doctor Contact Guide Attachment 73 – MPC Office-Based Doctor Contact Guide.docx Form and Instruction
Attachment 74 Attachment 74 – MPC Home Care Contact Attachment 74 – MPC Home Care Contact Guide.docx Form and Instruction
Attachment 75 Attachment 75 – MPC Institution Contact Guide Attachment 75 – MPC Institution Contact Guide.docx Form and Instruction
Attachment 76 Attachment 76 – MPC Pharmacy Contact Guide Attachment 76 – MPC Pharmacy Contact Guide.docx Form and Instruction
Attachment 77 Attachment 77 – MPC Separate Billing Doctor Contact Guid Attachment 77 – MPC Separate Billing Doctor Contact Guide.docx Form and Instruction

Information Collection (IC) Details

IC Title:	MPC Contact Guide/Screening Call	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Attachment 72	Attachment 72 – MPC Hospital Contact Guide	Attachment 72 – MPC Hospital Contact Guide.docx	Yes	Yes	Fillable Fileable
Form and Instruction	Attachment 73	Attachment 73 – MPC Office-Based Doctor Contact Guide	Attachment 73 – MPC Office-Based Doctor Contact Guide.docx	Yes	Yes	Fillable Fileable
Form and Instruction	Attachment 74	Attachment 74 – MPC Home Care Contact	Attachment 74 – MPC Home Care Contact Guide.docx	Yes	Yes	Fillable Fileable
Form and Instruction	Attachment 75	Attachment 75 – MPC Institution Contact Guide	Attachment 75 – MPC Institution Contact Guide.docx	Yes	Yes	Fillable Fileable
Form and Instruction	Attachment 76	Attachment 76 – MPC Pharmacy Contact Guide	Attachment 76 – MPC Pharmacy Contact Guide.docx	Yes	Yes	Fillable Fileable
Form and Instruction	Attachment 77	Attachment 77 – MPC Separate Billing Doctor Contact Guide	Attachment 77 – MPC Separate Billing Doctor Contact Guide.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 36,598	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	36,598	36,598
Annual IC Time Burden (Hours)	1,220	1,220
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.