Information Collection Request

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

ICR 202301-0935-001 · OMB 0935-0110 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form Form #3 Plan Questionnaire Form and Instruction Unchanged Available
Form Form #2 Establishment Questionnaire Form and Instruction Unchanged Repair queued
Form Form #1 Prescreener Questionnaire Form and Instruction Unchanged Available
SS Part B -- MEPS-IC 2023 - 2025_080322.docx Supporting Statement B Uploaded 2023-01-06 Available
SS Part A -- MEPS-IC 2023-2025.docx Supporting Statement A Uploaded 2023-01-06 Available
Attachment O -- Non-Response Bias Analysis of the 2014 MEPS-IC.docx Supplementary Document Uploaded 2022-12-01 Available
Attachment N - Definitions.pdf Supplementary Document Uploaded 2022-12-01 Available
Attachment M - Multi Unit Private Sector.pdf Supplementary Document Uploaded 2022-12-01 Available
Attachment L - Single Unit Private Sector.pdf Supplementary Document Uploaded 2022-12-01 Available
Attachment K - CMU Advance Letter.pdf Supplementary Document Uploaded 2022-12-01 Available
Attachment J - Certainty Government Initial Letter.pdf Supplementary Document Uploaded 2022-12-01 Available
Attachment I - Certainty Government Advance Letter.pdf Supplementary Document Uploaded 2022-12-01 Available
Attachment H - Noncertainty Government Initial Letter.pdf Supplementary Document Uploaded 2022-12-01 Available
Attachment G - Sample Strata 2023-2025.docx Supplementary Document Uploaded 2022-12-01 Available
Attachment F - Allocation by State 2023-2025.docx Supplementary Document Uploaded 2022-12-01 Available
Attachment E -- Confidentiality Form.docx Supplementary Document Uploaded 2022-12-01 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
182461 Plan Questionnaire Form and Instruction UnchangedPlan Questionnaire
182460 Establishment Questionnaire Form and Instruction Unchanged
182460 Establishment Questionnaire Unchanged
182459 Prescreener Questionnaire Form and Instruction UnchangedPrescreener Questionnaire

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
01/31/2026 36 Months From Approved 02/28/2023
91,204 0 106,040
17,461 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

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 91,204 106,040 0 -14,836 0 0
Annual Time Burden (Hours) 17,461 21,611 0 -4,150 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No