Information Collection Request
Medical Expenditure Panel Survey - Insurance Component (MEPS-IC)
ICR 202301-0935-001 · OMB 0935-0110 · Active
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0935-0110 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 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
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 182461 |  Plan Questionnaire |
Form and Instruction | Unchanged | |
| 182460 | Establishment Questionnaire |
Form and Instruction | Unchanged | |
| 182459 | Prescreener Questionnaire |
Form and Instruction | Unchanged |
ICR Details
| Status | Active |
|---|---|
| Agency/Subagency | HHS/AHRQ |
| OMB Control No | 0935-0110 |
| Type of Information Collection | Revision of a currently approved collection |
| Previous ICR Reference No | 202212-0935-001 |
| Agency Tracking No | 20656 |
| Date Submitted to OIRA | 2023-01-09 |
| Requested Expiration Date | 1969-12-31 |