Information Collection

MEPS-HC Core Interview

IC 37877 under ICR 202209-0935-003 · OMB 0935-0118.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Attachment 29 MEPS-HC Core Interview	Form and Instruction
Attachment 29 Attachment 29 –HC Access to Care Section Attachment 29 HC Access to Care Section.pdf	Form and Instruction
Attachment 29 Attachment 29 –HC Access to Care Section Attachment 29 HC Access to Care Section.pdf	Form and Instruction
Attachment 30 Attachment 30 – HC Condition Enumeration Section Attachment 30 HC Event Enumeration Section.pdf	Form and Instruction
Attachment 30 Attachment 30 – HC Condition Enumeration Section Attachment 30 HC Event Enumeration Section.pdf	Form and Instruction
Attachment 31 Attachment 31 – Attachment 31 HC Assets Section. Attachment 31 HC Assets Section.pdf	Form and Instruction
Attachment 31 Attachment 31 – Attachment 31 HC Assets Section. Attachment 31 HC Assets Section.pdf	Form and Instruction
Attachment 32 Attachment 32 – Attachment 32 HC Calendar Section Attachment 32 HC Calendar Section.pdf	Form and Instruction
Attachment 32 Attachment 32 – Attachment 32 HC Calendar Section Attachment 32 HC Calendar Section.pdf	Form and Instruction
Attachment 33 Attachment 33 Additional healthcare Section Attachment 33 Additional healthcare Section.pdf	Form and Instruction
Attachment 33 Attachment 33 Additional healthcare Section Attachment 33 Additional healthcare Section.pdf	Form and Instruction
Attachment 34 Attachment 34 HC Closing Section Attachment 34 HC Closing Section.pdf	Form and Instruction
Attachment 34 Attachment 34 HC Closing Section Attachment 34 HC Closing Section.pdf	Form and Instruction
Attachment 35 Attachment 35 HC Start_Restart Attachment 35 HC Start_Restart Section.pdf	Form and Instruction
Attachment 35 Attachment 35 HC Start_Restart Attachment 35 HC Start_Restart Section.pdf	Form and Instruction
Attachment 36 Attachment 36 HC Charge Payment Section Attachment 36 HC Charge Payment Section.pdf	Form and Instruction
Attachment 36 Attachment 36 HC Charge Payment Section Attachment 36 HC Charge Payment Section.pdf	Form and Instruction
Attachment 37 Attachment 37 HC Flat Fee Section Attachment 37 HC Flat Fee Section.pdf	Form and Instruction
Attachment 37 Attachment 37 HC Flat Fee Section Attachment 37 HC Flat Fee Section.pdf	Form and Instruction
Attachment 38 Attachment 38 – HC Child Preventive Health Supplement Se Attachment 38 Child Preventive Health Supplement Section.pdf	Form and Instruction
Attachment 38 Attachment 38 – HC Child Preventive Health Supplement Se Attachment 38 Child Preventive Health Supplement Section.pdf	Form and Instruction
Attachment 39 Attachment 39 – HC Institutional Care Section Attachment 39 HC Institutional Care Section.pdf	Form and Instruction
Attachment 39 Attachment 39 – HC Institutional Care Section Attachment 39 HC Institutional Care Section.pdf	Form and Instruction
Attachment 40 Attachment 40 – HC Dental Care Section Attachment 40 HC Dental Care Section.pdf	Form and Instruction
Attachment 40 Attachment 40 – HC Dental Care Section Attachment 40 HC Dental Care Section.pdf	Form and Instruction
Attachment 41 Attachment 41 – HC Event Driver Section Attachment 41 HC Event Driver Section.pdf	Form and Instruction
Attachment 41 Attachment 41 – HC Event Driver Section Attachment 41 HC Event Driver Section.pdf	Form and Instruction
Attachment 42 Attachment 42 – HC Employment (EM) Section Attachment 42 HC Employment (EM) Section.pdf	Form and Instruction
Attachment 42 Attachment 42 – HC Employment (EM) Section Attachment 42 HC Employment (EM) Section.pdf	Form and Instruction
Attachment 43 Attachment 43 – HC Review of Employment Information (RJ) Attachment 43 HC Review of Employment Information (RJ) Section.pdf	Form and Instruction
Attachment 43 Attachment 43 – HC Review of Employment Information (RJ) Attachment 43 HC Review of Employment Information (RJ) Section.pdf	Form and Instruction
Attachment 44 Attachment 44 – HC Employment Driver (OE) Section Attachment 44 HC Employment Driver (OE) Section.pdf	Form and Instruction
Attachment 44 Attachment 44 – HC Employment Driver (OE) Section Attachment 44 HC Employment Driver (OE) Section.pdf	Form and Instruction
Attachment 45 Attachment 45 – HC Employment Wage (EW) Section Attachment 45 Employment Wage (EW) Section.pdf	Form and Instruction
Attachment 45 Attachment 45 – HC Employment Wage (EW) Section Attachment 45 Employment Wage (EW) Section.pdf	Form and Instruction
Attachment 46 Attachment 46 – HC Emergency Room Section Attachment 46 Emergency Room Section.pdf	Form and Instruction
Attachment 46 Attachment 46 – HC Emergency Room Section Attachment 46 Emergency Room Section.pdf	Form and Instruction
Attachment 47 Attachment 47 Event Roster Section Attachment 47 Event Roster Section.pdf	Form and Instruction
Attachment 47 Attachment 47 Event Roster Section Attachment 47 Event Roster Section.pdf	Form and Instruction
Attachment 48 Attachment 48 Health Status Section Attachment 48 Health Status Section.pdf	Form and Instruction
Attachment 48 Attachment 48 Health Status Section Attachment 48 Health Status Section.pdf	Form and Instruction
Attachment 49 Attachment 49 HC Help Text Attachment 49 HC Help Text.pdf	Form and Instruction
Attachment 49 Attachment 49 HC Help Text Attachment 49 HC Help Text.pdf	Form and Instruction
Attachment 50 Attachment 50 Home Health Section Attachment 50 Home Health Section.pdf	Form and Instruction
Attachment 50 Attachment 50 Home Health Section Attachment 50 Home Health Section.pdf	Form and Instruction
Attachment 51 Attachment 51 Health Insurance (HX) Section Attachment 51 Health Insurance (HX) Section.pdf	Form and Instruction
Attachment 51 Attachment 51 Health Insurance (HX) Section Attachment 51 Health Insurance (HX) Section.pdf	Form and Instruction
Attachment 52 HC Attachment 52 HC Private Health Insurance Detail (HP) Se Attachment 52 HC Private Health Insurance Detail (HP) Section.pdf	Form and Instruction
Attachment 52 HC Attachment 52 HC Private Health Insurance Detail (HP) Se Attachment 52 HC Private Health Insurance Detail (HP) Section.pdf	Form and Instruction
Attachment 53 Attachment 53 HC Time Covered Detail (HQ) Section Attachment 53 HC Time Covered Detail (HQ) Section.pdf	Form and Instruction
Attachment 53 Attachment 53 HC Time Covered Detail (HQ) Section Attachment 53 HC Time Covered Detail (HQ) Section.pdf	Form and Instruction
Attachment 54 Attachment 54 HC Managed Care (MC) Section Attachment 54 HC Managed Care (MC) Section.pdf	Form and Instruction
Attachment 54 Attachment 54 HC Managed Care (MC) Section Attachment 54 HC Managed Care (MC) Section.pdf	Form and Instruction
Attachment 55 Attachment 55 HC Old Employment Health Insurance (OE) Se Attachment 55 HC Old Employment Health Insurance (OE) Section.pdf	Form and Instruction
Attachment 55 Attachment 55 HC Old Employment Health Insurance (OE) Se Attachment 55 HC Old Employment Health Insurance (OE) Section.pdf	Form and Instruction
Attachment 56 Attachment 56 HC Old Public Related Insurance (PR) Secti Attachment 56 HC Old Public Related Insurance (PR) Section.pdf	Form and Instruction
Attachment 56 Attachment 56 HC Old Public Related Insurance (PR) Secti Attachment 56 HC Old Public Related Insurance (PR) Section.pdf	Form and Instruction
Attachment 57 Attachment 57 HC Hospital Stay Section Attachment 57 HC Hospital Stay Section.pdf	Form and Instruction
Attachment 57 Attachment 57 HC Hospital Stay Section Attachment 57 HC Hospital Stay Section.pdf	Form and Instruction
Attachment 58 Attachment 58 HC Income Section Attachment 58 HC Income Section.pdf	Form and Instruction
Attachment 58 Attachment 58 HC Income Section Attachment 58 HC Income Section.pdf	Form and Instruction
Attachment 59 Attachment 59 HC Medical Provider Section Attachment 59 HC Medical Provider Section.pdf	Form and Instruction
Attachment 59 Attachment 59 HC Medical Provider Section Attachment 59 HC Medical Provider Section.pdf	Form and Instruction
Attachment 60 Attachment 60 HC Other Medical Expense Section Attachment 60 HC Other Medical Expense Section.pdf	Form and Instruction
Attachment 60 Attachment 60 HC Other Medical Expense Section Attachment 60 HC Other Medical Expense Section.pdf	Form and Instruction
Attachment 61 Attachment 61 HC Outpatient Department Section Attachment 61 HC Outpatient Department Section.pdf	Form and Instruction
Attachment 61 Attachment 61 HC Outpatient Department Section Attachment 61 HC Outpatient Department Section.pdf	Form and Instruction
Attachment 62 Attachment 62 HC Quality Supplement Section Attachment 62 HC Quality Supplement Section.pdf	Form and Instruction
Attachment 62 Attachment 62 HC Quality Supplement Section Attachment 62 HC Quality Supplement Section.pdf	Form and Instruction
Attachment 63 Attachment 63 HC Respondent Forms Section Attachment 63 HC Respondent Forms Section.pdf	Form and Instruction
Attachment 63 Attachment 63 HC Respondent Forms Section Attachment 63 HC Respondent Forms Section.pdf	Form and Instruction
Attachment 64 Attachment 64 HC Priority Conditions Enumeration Section Attachment 64 HC Priority Conditions Enumeration Section.pdf	Form and Instruction
Attachment 64 Attachment 64 HC Priority Conditions Enumeration Section Attachment 64 HC Priority Conditions Enumeration Section.pdf	Form and Instruction
Attachment 65 Attachment 65 HC Prescribed Medicines Section Attachment 65 HC Prescribed Medicines Section.pdf	Form and Instruction
Attachment 65 Attachment 65 HC Prescribed Medicines Section Attachment 65 HC Prescribed Medicines Section.pdf	Form and Instruction
Attachment 66 Attachment 66 HC Provider Probes Section Attachment 66 HC Provider Probes Section.pdf	Form and Instruction
Attachment 66 Attachment 66 HC Provider Probes Section Attachment 66 HC Provider Probes Section.pdf	Form and Instruction
Attachment 67 Attachment 67 HC Provider Roster Section Attachment 67 HC Provider Roster Section.pdf	Form and Instruction
Attachment 67 Attachment 67 HC Provider Roster Section Attachment 67 HC Provider Roster Section.pdf	Form and Instruction
Attachment 68 Attachment 68 HC Reenumeration Subsection Attachment 68 HC Reenumeration Subsection A.pdf	Form and Instruction
Attachment 68 Attachment 68 HC Reenumeration Subsection Attachment 68 HC Reenumeration Subsection A.pdf	Form and Instruction
Attachment 69 Attachment 69 HC Reenumeration Subsection B Attachment 69 HC Reenumeration Subsection B.pdf	Form and Instruction
Attachment 69 Attachment 69 HC Reenumeration Subsection B Attachment 69 HC Reenumeration Subsection B.pdf	Form and Instruction
Attachment 70 Attachment 70 HC RU Information Screener Attachment 70 HC RU Information Screener.docx	Form and Instruction
Attachment 70 Attachment 70 HC RU Information Screener Attachment 70 HC RU Information Screener.docx	Form and Instruction
Attachment 71 Attachment 71 HC Event Follow Up Section Attachment 71 HC Event Follow Up Section.pdf	Form and Instruction
Attachment 71 Attachment 71 HC Event Follow Up Section Attachment 71 HC Event Follow Up Section.pdf	Form and Instruction
02-HC Why is Participation in MEPS so Important.pdf Attachment 2 - HC Why is Participation in MEPS so Important	IC Document
02-HC Why is Participation in MEPS so Important.pdf Attachment 2 - HC Why is Participation in MEPS so Important	IC Document
Attachment 4 -- HC Policy Impact Award.doc Attachment 4 -- HC Policy Impact Award	IC Document
Attachment 4 -- HC Policy Impact Award.doc Attachment 4 -- HC Policy Impact Award	IC Document
03-HC MEPS A Survey of Health Care Use and Spending.pdf Attachment 3 -- HC MEPS A Survey of Health Care Use and Spending	IC Document
03-HC MEPS A Survey of Health Care Use and Spending.pdf Attachment 3 -- HC MEPS A Survey of Health Care Use and Spending	IC Document
08-HC Important Information About Your Participatio in MEPS.doc Attachment 8 – HC Important Information About Your Participation in MEPS	IC Document
08-HC Important Information About Your Participatio in MEPS.doc Attachment 8 – HC Important Information About Your Participation in MEPS	IC Document
09-HC MEPS Data Example&FAQs.docx Attachment 9 – HC MEPS Data Example & FAQs	IC Document
09-HC MEPS Data Example&FAQs.docx Attachment 9 – HC MEPS Data Example & FAQs	IC Document
10-HC Respondent Letters, Postcards and Notes.docx Attachment 10 – HC Respondent Letters, Postcards and Notes	IC Document
10-HC Respondent Letters, Postcards and Notes.docx Attachment 10 – HC Respondent Letters, Postcards and Notes	IC Document
11-HC MEPS FAQs Brochure.docx Attachment 11 – HC MEPS FAQs Brochure	IC Document
11-HC MEPS FAQs Brochure.docx Attachment 11 – HC MEPS FAQs Brochure	IC Document
12-HC MEPS Monthly Planner.pdf Attachment 12 – HC MEPS Monthly Planner	IC Document
12-HC MEPS Monthly Planner.pdf Attachment 12 – HC MEPS Monthly Planner	IC Document
13-HC MEPS Record Keeper.pdf Attachment 13 – HC MEPS Record Keeper	IC Document
13-HC MEPS Record Keeper.pdf Attachment 13 – HC MEPS Record Keeper	IC Document
14-HC Showcards.docx Attachment 14 – HC Showcards	IC Document
14-HC Showcards.docx Attachment 14 – HC Showcards	IC Document
16-HC Certificate of Appreciation.pdf Attachment 16 – HC Certificate of Appreciation	IC Document
16-HC Certificate of Appreciation.pdf Attachment 16 – HC Certificate of Appreciation	IC Document
17-HC Who Uses MEPS Data.docx Attachment 17 – HC Who Uses MEPS Data	IC Document
17-HC Who Uses MEPS Data.docx Attachment 17 – HC Who Uses MEPS Data	IC Document
24-MEPS Tip Sheet.docx Attachment 24 – HC MEPS Tip Sheet	IC Document
24-MEPS Tip Sheet.docx Attachment 24 – HC MEPS Tip Sheet	IC Document
25-HC Tips for Making Your MEPS Interview Easier.docx Attachment 25 – HC Tips for Making Your MEPS Interview Easier	IC Document
25-HC Tips for Making Your MEPS Interview Easier.docx Attachment 25 – HC Tips for Making Your MEPS Interview Easier	IC Document
05-HC About the MEPS-MPC Authorization Form.docx Attachment 5 – HC About the MEPS-MPC Authorization Form	IC Document
05-HC About the MEPS-MPC Authorization Form.docx Attachment 5 – HC About the MEPS-MPC Authorization Form	IC Document
06-HC Data protection is word ONE with MEPS.doc Attachment 6 – HC Data protection is word ONE with MEPS	IC Document
06-HC Data protection is word ONE with MEPS.doc Attachment 6 – HC Data protection is word ONE with MEPS	IC Document
15-HC Validation Letter.doc Attachment 15 – HC Validation Letter	IC Document
15-HC Validation Letter.doc Attachment 15 – HC Validation Letter	IC Document
04-HC What MEPS tells us about...Charts.docx Attachment 4 – HC What MEPS tells us about…Charts	IC Document
04-HC What MEPS tells us about...Charts.docx Attachment 4 – HC What MEPS tells us about…Charts	IC Document
Attachment 7 HC Respondent Recruitment Video Link.msg Attachment 7 – HC Respondent Recruitment Video	IC Document
Attachment 7 HC Respondent Recruitment Video Link.msg Attachment 7 – HC Respondent Recruitment Video	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

MEPS-HC Core Interview

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Attachment 29	Attachment 29 âHC Access to Care Section	Attachment 29 HC Access to Care Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Attachment 30	Attachment 30 â HC Condition Enumeration Section	Attachment 30 HC Event Enumeration Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Attachment 31	Attachment 31 â Attachment 31 HC Assets Section.	Attachment 31 HC Assets Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Attachment 32	Attachment 32 â Attachment 32 HC Calendar Section	Attachment 32 HC Calendar Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Attachment 33	Attachment 33 Additional healthcare Section	Attachment 33 Additional healthcare Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Attachment 34	Attachment 34 HC Closing Section	Attachment 34 HC Closing Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Attachment 35	Attachment 35 HC Start_Restart	Attachment 35 HC Start_Restart Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Attachment 36	Attachment 36 HC Charge Payment Section	Attachment 36 HC Charge Payment Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Attachment 37	Attachment 37 HC Flat Fee Section	Attachment 37 HC Flat Fee Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Attachment 38	Attachment 38 â HC Child Preventive Health Supplement Section	Attachment 38 Child Preventive Health Supplement Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Attachment 39	Attachment 39 â HC Institutional Care Section	Attachment 39 HC Institutional Care Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Attachment 40	Attachment 40 â HC Dental Care Section	Attachment 40 HC Dental Care Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Attachment 41	Attachment 41 â HC Event Driver Section	Attachment 41 HC Event Driver Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Attachment 42	Attachment 42 â HC Employment (EM) Section	Attachment 42 HC Employment (EM) Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Attachment 43	Attachment 43 â HC Review of Employment Information (RJ) Section	Attachment 43 HC Review of Employment Information (RJ) Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Attachment 44	Attachment 44 â HC Employment Driver (OE) Section	Attachment 44 HC Employment Driver (OE) Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Attachment 45	Attachment 45 â HC Employment Wage (EW) Section	Attachment 45 Employment Wage (EW) Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Attachment 46	Attachment 46 â HC Emergency Room Section	Attachment 46 Emergency Room Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Attachment 47	Attachment 47 Event Roster Section	Attachment 47 Event Roster Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Attachment 48	Attachment 48 Health Status Section	Attachment 48 Health Status Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Attachment 49	Attachment 49 HC Help Text	Attachment 49 HC Help Text.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Attachment 50	Attachment 50 Home Health Section	Attachment 50 Home Health Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Attachment 51	Attachment 51 Health Insurance (HX) Section	Attachment 51 Health Insurance (HX) Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Attachment 52 HC	Attachment 52 HC Private Health Insurance Detail (HP) Section	Attachment 52 HC Private Health Insurance Detail (HP) Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Attachment 53	Attachment 53 HC Time Covered Detail (HQ) Section	Attachment 53 HC Time Covered Detail (HQ) Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Attachment 54	Attachment 54 HC Managed Care (MC) Section	Attachment 54 HC Managed Care (MC) Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Attachment 55	Attachment 55 HC Old Employment Health Insurance (OE) Section	Attachment 55 HC Old Employment Health Insurance (OE) Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Attachment 56	Attachment 56 HC Old Public Related Insurance (PR) Section	Attachment 56 HC Old Public Related Insurance (PR) Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Attachment 57	Attachment 57 HC Hospital Stay Section	Attachment 57 HC Hospital Stay Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Attachment 58	Attachment 58 HC Income Section	Attachment 58 HC Income Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Attachment 59	Attachment 59 HC Medical Provider Section	Attachment 59 HC Medical Provider Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Attachment 60	Attachment 60 HC Other Medical Expense Section	Attachment 60 HC Other Medical Expense Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Attachment 61	Attachment 61 HC Outpatient Department Section	Attachment 61 HC Outpatient Department Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Attachment 62	Attachment 62 HC Quality Supplement Section	Attachment 62 HC Quality Supplement Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Attachment 63	Attachment 63 HC Respondent Forms Section	Attachment 63 HC Respondent Forms Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Attachment 64	Attachment 64 HC Priority Conditions Enumeration Section	Attachment 64 HC Priority Conditions Enumeration Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Attachment 65	Attachment 65 HC Prescribed Medicines Section	Attachment 65 HC Prescribed Medicines Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Attachment 66	Attachment 66 HC Provider Probes Section	Attachment 66 HC Provider Probes Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Attachment 67	Attachment 67 HC Provider Roster Section	Attachment 67 HC Provider Roster Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Attachment 68	Attachment 68 HC Reenumeration Subsection	Attachment 68 HC Reenumeration Subsection A.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Attachment 69	Attachment 69 HC Reenumeration Subsection B	Attachment 69 HC Reenumeration Subsection B.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Attachment 70	Attachment 70 HC RU Information Screener	Attachment 70 HC RU Information Screener.docx	Yes	Yes	Fillable Fileable
Form and Instruction	Attachment 71	Attachment 71 HC Event Follow Up Section	Attachment 71 HC Event Follow Up Section.pdf	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 13,338

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	33,345	33,345
Annual IC Time Burden (Hours)	51,129	51,129
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment 2 - HC Why is Participation in MEPS so Important	02-HC Why is Participation in MEPS so Important.pdf	09/10/2015
Attachment 4 -- HC Policy Impact Award	Attachment 4 -- HC Policy Impact Award.doc	09/24/2012
Attachment 3 -- HC MEPS A Survey of Health Care Use and Spending	03-HC MEPS A Survey of Health Care Use and Spending.pdf	09/10/2015
Attachment 8 â HC Important Information About Your Participation in MEPS	08-HC Important Information About Your Participatio in MEPS.doc	09/11/2015
Attachment 9 â HC MEPS Data Example & FAQs	09-HC MEPS Data Example&FAQs.docx	09/11/2015
Attachment 10 â HC Respondent Letters, Postcards and Notes	10-HC Respondent Letters, Postcards and Notes.docx	09/11/2015
Attachment 11 â HC MEPS FAQs Brochure	11-HC MEPS FAQs Brochure.docx	09/11/2015
Attachment 12 â HC MEPS Monthly Planner	12-HC MEPS Monthly Planner.pdf	09/11/2015
Attachment 13 â HC MEPS Record Keeper	13-HC MEPS Record Keeper.pdf	09/11/2015
Attachment 14 â HC Showcards	14-HC Showcards.docx	09/11/2015
Attachment 16 â HC Certificate of Appreciation	16-HC Certificate of Appreciation.pdf	09/11/2015
Attachment 17 â HC Who Uses MEPS Data	17-HC Who Uses MEPS Data.docx	09/11/2015
Attachment 24 â HC MEPS Tip Sheet	24-MEPS Tip Sheet.docx	09/11/2015
Attachment 25 â HC Tips for Making Your MEPS Interview Easier	25-HC Tips for Making Your MEPS Interview Easier.docx	09/11/2015
Attachment 5 â HC About the MEPS-MPC Authorization Form	05-HC About the MEPS-MPC Authorization Form.docx	09/10/2015
Attachment 6 â HC Data protection is word ONE with MEPS	06-HC Data protection is word ONE with MEPS.doc	09/11/2015
Attachment 15 â HC Validation Letter	15-HC Validation Letter.doc	09/11/2015
Attachment 4 â HC What MEPS tells us aboutâ¦Charts	04-HC What MEPS tells us about...Charts.docx	09/10/2015
Attachment 7 â HC Respondent Recruitment Video	Attachment 7 HC Respondent Recruitment Video Link.msg	09/11/2015

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