Attachment 19 – HC Adult SAQ – Male

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

OMB: 0935-0118

IC ID: 230227

Information Collection (IC) Details

View Information Collection (IC)

Attachment 19 – HC Adult SAQ – Male
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction Attachment 19 Attachment 19 – HC Adult SAQ – Male Attachment 19 HC Adult SAQ Male.docx No   Paper Only
Form and Instruction Attachment 18 Attachment 18 HC Adult SAQ Attachment 18 HC Adult SAQ.pdf No   Paper Only

Health Health Care Services

 

11,985 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 11,985 0 0 0 0 11,985
Annual IC Time Burden (Hours) 1,398 0 0 0 0 1,398
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
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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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