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Federal forms, ICRs, and supporting documents

Information Collection

Pilot Test of the Revised Data Collection Method for the Medical Expenditure Panel Survey - Insurance Component

IC 246524 under ICR 202401-0935-006 · OMB 0935-0124.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Pilot Test of the Revised Data Collection Method for the Medical Expenditure Panel Survey - Insurance Component
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 1 Pilot test – Establishment Questionnaire meps10_033121 v2.pdf Yes Yes Fillable Fileable
Form and Instruction 2 Pilot test – Plan Questionnaire meps10s_033121 v2.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

3,000 0
   
Private Sector Businesses or other for-profits
 
   100 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 3,000 0 0 0 0 3,000
Annual IC Time Burden (Hours) 1,180 0 0 0 0 1,180
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Cover Letter OMB Cover Letter.docx 03/31/2021
Supporting Statement Part A Supporting Statement Part A - Pilot test MEPS-IC_v2_052421.docx 05/24/2021
Supporting Statement Part B Supporting Statement Part B - Pilot Test of MEPS-IC Revised Data Collection Method - 3-24-2021 v2.docx 03/31/2021
2021 Forms 20D 2021 Survey Forms-20D.pdf 05/24/2021
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.