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Home care for non health care providers questionnaire
Medical Expenditure Panel Survey - Household and Medical Provider Components
OMB: 0935-0118
IC ID: 191102
OMB.report
HHS/AHRQ
OMB 0935-0118
ICR 202401-0935-001
IC 191102
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0935-0118 can be found here:
2024-07-02 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
Form Attachment 82
Home care for non health care providers questionnaire
Form and Instruction
Attachment 82 Attachment 82 – MPC Home Care Provider Questionnaire for Non-Health Care Providers
Attachment 82 – MPC Home Care Provider Questionnaire for Non-Health Care Providers.docx
Form and Instruction
Attachment 75 MPC HomeHealth_Phone_AF_Packet.doc
Attachment 75 – MPC Home Care Provider Authorization Form Package, Phone Data Collection Anticipated
IC Document
Attachment 76 MPC HomeHealth_Fax_AF_Packet.doc
Attachment 76 – MPC Home Care Provider Authorization Form Package, Records to be Provided via Fax Anticipated
IC Document
Attachment 77 MPC HomeHealth_Overflow_Patient_List.docx
Attachment 77 – MPC Home Care Provider Overflow Patient List
IC Document
Information Collection (IC) Details
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