Information Collection Request

Medical Expenditure Panel Survey - Insurance Component (MEPS-IC)

ICR 202212-0935-001 · OMB 0935-0110 · Historical Inactive

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form Form #3 Plan Questionnaire Form and Instruction Modified Available
Form Form #3 Plan Questionnaire Form and Instruction Modified Repair queued
Form Form #2 Establishment Questionnaire Form and Instruction Modified Available
Form Form #2 Establishment Questionnaire Form and Instruction Modified Repair queued
Form Form #1 Prescreener Questionnaire Form and Instruction Modified Available
Form Form #1 Prescreener Questionnaire Form and Instruction Modified Repair queued
Attachment O -- Non-Response Bias Analysis of the 2014 MEPS-IC.docx Supplementary Document Uploaded 2022-12-01 Repair queued
Attachment N - Definitions.pdf Supplementary Document Uploaded 2022-12-01 Repair queued
Attachment M - Multi Unit Private Sector.pdf Supplementary Document Uploaded 2022-12-01 Repair queued
Attachment L - Single Unit Private Sector.pdf Supplementary Document Uploaded 2022-12-01 Repair queued
Attachment K - CMU Advance Letter.pdf Supplementary Document Uploaded 2022-12-01 Repair queued
Attachment J - Certainty Government Initial Letter.pdf Supplementary Document Uploaded 2022-12-01 Repair queued
Attachment I - Certainty Government Advance Letter.pdf Supplementary Document Uploaded 2022-12-01 Repair queued
Attachment H - Noncertainty Government Initial Letter.pdf Supplementary Document Uploaded 2022-12-01 Repair queued
Attachment G - Sample Strata 2023-2025.docx Supplementary Document Uploaded 2022-12-01 Repair queued
Attachment F - Allocation by State 2023-2025.docx Supplementary Document Uploaded 2022-12-01 Repair queued
Attachment E -- Confidentiality Form.docx Supplementary Document Uploaded 2022-12-01 Repair queued
SS Part B -- MEPS-IC 2023 - 2025_080322.docx Supporting Statement B Uploaded 2022-12-01 Repair queued
SS Part A -- MEPS-IC 2023-2025.docx Supporting Statement A Uploaded 2022-12-01 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
182461 Plan Questionnaire Form and Instruction ModifiedPlan Questionnaire
182461 Plan Questionnaire Form and Instruction Modified
182460 Establishment Questionnaire Form and Instruction ModifiedEstablishment Questionnaire
182460 Establishment Questionnaire Form and Instruction Modified
182459 Prescreener Questionnaire Form and Instruction ModifiedPrescreener Questionnaire
182459 Prescreener Questionnaire Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
02/28/2023 36 Months From Approved 02/28/2023
106,040 0 106,040
21,611 0 21,611
0 0 0





Reginfo record details
3
table that charts list of burden
IC Title Form No. Form Name
Establishment Questionnaire Form #2
Plan Questionnaire Form #3
Prescreener Questionnaire Form #1



Reginfo record details
  No