MEPS Alternative Sampling Design Pilot Test

Questionnaire and Data Collection Testing, Evaluation, and Research for the Agency for Healthcare Research and Quality

OMB: 0935-0124

IC ID: 252822

Documents and Forms
Document Name
Document Type
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)

MEPS Alternative Sampling Design Pilot Test
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 1 Pilot Screener Attachment A.docx Yes Yes Fillable Fileable

Health Health Care Services

 

3,393 0
   
Individuals or Households
 
   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 3,393 0 0 0 0 3,393
Annual IC Time Burden (Hours) 567 0 0 0 0 567
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Cover Letter Cover Letter.docx 04/11/2022
Attachment B – Pilot Mailing Materials Attachment B.docx 04/11/2022
Supporting Statement Part A SS A clean.docx 05/24/2022
Supporting Statement Part B SS B Clean.docx 05/24/2022
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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