Information Collection

MEPS-HC Cognitive Testing

IC 280554 under ICR 202401-0935-006 · OMB 0935-0124.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Attachment 1- Cognitive Testing Materials for Pre- R1 MEPS-HC Cognitive Testing	Form and Instruction
Form 2 Attachment 2- Cognitive Testing Materials for Health Care Entry MEPS-HC Cognitive Testing	Form and Instruction
Form 3 Attachment 3- Blue Button Access Authorization Script MEPS-HC Cognitive Testing	Form and Instruction
Form 4 Attachment 4- Generic claims authorization script MEPS-HC Cognitive Testing	Form and Instruction
1 Attachment 1- Cognitive Testing Materials for Pre- R1 Attachment 1 -- Cognitive Testing Materials for Pre-R1.pdf	Form and Instruction
2 Attachment 2- Cognitive Testing Materials for Health Car Attachment 2 -- Cognitive Testing Materials for Health Care Entry.pdf	Form and Instruction
3 Attachment 3- Blue Button Access Authorization Script Attachment 3 -- Blue Button Access Authorization Script.pdf	Form and Instruction
4 Attachment 4- Generic claims authorization script Attachment 4 -- Generic claims authorization script.pdf	Form and Instruction
MEPS Gen4 CogTest_Generic 0935-Short-Form-OMB Passback-30May2026_response_clean.docx Gen IC- Cognitive Testing	IC Document

IC Title:

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Yes	Yes	Fillable Fileable
Form and Instruction	2	Yes	Yes	Fillable Fileable
Form and Instruction	3	Yes	Yes	Fillable Fileable
Form and Instruction	4	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 150

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 75 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	150	150
Annual IC Time Burden (Hours)	150	150
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Gen IC- Cognitive Testing		06/12/2026

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

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