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Institutions (non-hospital) questionnaire
Medical Expenditure Panel Survey - Household and Medical Provider Components
OMB: 0935-0118
IC ID: 191106
OMB.report
HHS/AHRQ
OMB 0935-0118
ICR 202401-0935-001
IC 191106
( )
⚠️ Notice: This information collection may be referencing outdated material.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 96
Institutions (non-hospital) questionnaire
Form and Instruction
Attachment 96 Attachment 96 – MPC Institution Provider Questionnaire
Attachment 96 – MPC Institution Provider Questionnaire.docx
Form and Instruction
Attachment 88 MPC Hospital_MRPA_AF_Packet.doc
Attachment 88 – MPC Hospital Provider Authorization Form Package, One Point of Contact for Medical and Patient Account Records
IC Document
Attachment 89 MPC Hospital_MR_AF_Packet.doc
Attachment 89 – MPC Hospital Provider Authorization Form Package, Point of Contact for Medical Records
IC Document
Attachment 90 MPC Hospital_PA_AF_Packet.doc
Attachment 90 – MPC Hospital Provider Authorization Form Package, Point of Contact for Patient Account Records
IC Document
Attachment 91 MPC Hospital_Overflow_Patient_List.docx
Attachment 91 – MPC Hospital Provider Overflow Patient List
IC Document
Attachment 93 MPC Letter.docx
Attachment 93 – MPC Letters, Email Templates, and Other Documents
IC Document
Information Collection (IC) Details
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