Information Collection

COVID-19 and Telehealth (telemedicine) questions included in the MEPS questionnaire

IC 242880 under ICR 202401-0935-001 · OMB 0935-0118.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0935-0118 can be found here:

Documents and Forms

Document Name Document Type
Form Attachment A – COV COVID-19 and Telehealth (telemedicine) questions included in the MEPS questionnaire Form and Instruction
Attachment A – COV Attachment A – COVID-19 Questions Attachment A. CV (COVID19 Access to Care) Updated.docx Form and Instruction
Attachment A – COV Attachment A – COVID-19 Questions Attachment A. CV (COVID19 Access to Care) Updated.docx Form and Instruction
Attachment B Attachment B Attachment B. TH Draft V1.docx Form and Instruction
Attachment B Attachment B Attachment B. TH Draft V1.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	COVID-19 and Telehealth (telemedicine) questions included in the MEPS questionnaire	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Attachment A â COVID-19 Questions	Attachment A â COVID-19 Questions	Attachment A. CV (COVID19 Access to Care) Updated.docx		Yes	Yes	Fillable Fileable
Form and Instruction	Attachment B	Attachment B	Attachment B. TH Draft V1.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 13,338	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 90 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-13,338	13,338
Annual IC Time Burden (Hours)	-222	222
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.