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HC Adult SAQ that includes Mental Health Questions
Medical Expenditure Panel Survey - Household and Medical Provider Components
OMB: 0935-0118
IC ID: 236894
OMB.report
HHS/AHRQ
OMB 0935-0118
ICR 202401-0935-001
IC 236894
( )
⚠️ Notice: This information collection may be referencing outdated material.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 106a
HC Adult SAQ that includes Mental Health Questions
Form and Instruction
106a Attachment 106a.REV_Female PSAQ with Mental Health Content
Attachment 106a.REV_Female PSAQ with Mental Health Content_for OMB.pdf
Form and Instruction
106b Attachment106b.REV_Male PSAQ with Mental Health Content
Attachment106b.REV_Male PSAQ with Mental Health Content_for OMB.pdf
Form and Instruction
Information Collection (IC) Details
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