Medical Expenditure Panel Survey - Household and Medical Provider Components

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 MEPS-HC Core Interview	Form and Instruction	Modified	Missing upstream
Form 63 Burdens and Economic Impacts of Medical Care SAQ	Form and Instruction	New	Repair queued
Form 2a Cancer SAQ	Form and Instruction	Removed	Repair queued
Form 49 Preventive Care SAQ	Form and Instruction	Modified	Repair queued
Form 48 Adult SAQ	Form and Instruction	Modified	Missing upstream
Form 55 MPC Contact Guide/Screening Call	Form and Instruction	Modified	Repair queued
Form 54a MEPS-HC Validation Interview	Form and Instruction	Modified	Repair queued
Form 52 Authorization Form for the MEPS-MPC Provider and Pharmacy Survey	Form and Instruction	Modified	Available
Form 62 Pharmacies Event Form	Form and Instruction	Modified	Repair queued
Form 61 Institutions (non-hospital) Event Form	Form and Instruction	Modified	Repair queued
Form 60 Hospitals Event Form	Form and Instruction	Modified	Repair queued
Form 59 Separately Billing Doctors Form	Form and Instruction	Modified	Missing upstream
Form 58 Office Based Providers Form	Form and Instruction	Modified	Missing upstream
Form 56 Home Care Providers Event Form	Form and Instruction	Modified	Missing upstream
Form 50 Diabetes Care SAQ	Form and Instruction	Modified	Repair queued
SS Part A - MEPS-HC MPC - Economic Burden SAQ - 2025 062724.docx	Supporting Statement A	Uploaded 2024-07-02	Repair queued
SS Part B - MEPS-HC MPC - Economic Burden SAQ - 06122024.docx	Supporting Statement B	Uploaded 2024-07-02	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
37877	MEPS-HC Core Interview	Form and Instruction	Modified
269113	Burdens and Economic Impacts of Medical Care SAQ	Form and Instruction	New
264332	Cancer SAQ	Form and Instruction	Removed
264315	Preventive Care SAQ	Form and Instruction	Modified
264201	Adult SAQ	Form and Instruction	Modified
204200	MPC Contact Guide/Screening Call	Form and Instruction	Modified
204199	MEPS-HC Validation Interview	Form and Instruction	Modified
204197	Authorization Form for the MEPS-MPC Provider and Pharmacy Survey	Form and Instruction	Modified
191107	Pharmacies Event Form	Form and Instruction	Modified
191106	Institutions (non-hospital) Event Form	Form and Instruction	Modified
191105	Hospitals Event Form	Form and Instruction	Modified
191104	Separately Billing Doctors Form	Form and Instruction	Modified
191103	Office Based Providers Form	Form and Instruction	Modified
191101	Home Care Providers Event Form	Form and Instruction	Modified
191099	Diabetes Care SAQ	Form and Instruction	Modified

ICR Details

OMB Control No: 0935-0118	ICR Reference No: 202406-0935-002
Status: Received in OIRA	Previous ICR Reference No: 202401-0935-001
Agency/Subagency: HHS/AHRQ	Agency Tracking No:
Title: Medical Expenditure Panel Survey - Household and Medical Provider Components
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 07/02/2024

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	03/31/2027
Responses	384,693	642,279
Time Burden (Hours)	67,489	76,499
Cost Burden (Dollars)	0	0

---

Abstract: The MEPS was initiated in 1996. Each year a new panel of sample households is selected. Recent annual MEPS-HC sample sizes average about 13,500 households. Data can be analyzed at either the person, family, or event level. The panel design of the survey, which includes 5 Rounds of interviews covering 2 full calendar years, provides data for examining person level changes in selected variables such as expenditures, health insurance coverage, and health status (see Medical Expenditure Panel Survey Content Summary of the Household Interview (ahrq.gov) for information on how the Covid-19 pandemic impacted this design). Using a combination of computer assisted personal interviewing (CAPI), computer assisted video interviewing (CAVI), and self-administered paper and web questionnaires, information about each household member is collected, and the survey builds on this information from interview to interview. CAVI is a new data collection technology and offers the best of both telephone and in-person interviewing, while offering opportunities for cost savings and more accurate reporting. This Information Collection Request (ICR) is for a revision to the Medical Expenditures Panel Survey – Household Component (MEPS-HC). These changes will be fielded in the Spring and Fall of 2025 and includes the addition of the Burdens and Economic Impacts of Medical Care Self-Administered Questionnaire (ESAQ), minor changes to questions in both the Core MEPS Interview and the Adult SAQ and removing the Cancer SAQ (CSAQ).

---

Authorizing Statute(s): US Code: 42 USC 299 Name of Law: Agency for Healthcare Research and Quality Act of 1999
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 28784	04/19/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 54466	07/01/2024
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 14

table that charts list of burden

IC Title	Form No.	Form Name
Adult SAQ	48	Adult SAQ
Authorization Form for the MEPS-MPC Provider and Pharmacy Survey	52, 53	Permission Form for Medical Providers ,   Permission Form for Pharmacies
Burdens and Economic Impacts of Medical Care SAQ	63	Burdens and Economic Impacts of Medical Care SAQ
Cancer SAQ	2a	Cancer SAQ
Diabetes Care SAQ	50	Diabetes Care SAQ
Home Care Providers Event Form	56, 57	Home Healthcare for Healthcare Providers ,   Home Healthcare for Non-healthcare Providers
Hospitals Event Form	60	Hospital Event Form
Institutions (non-hospital) Event Form	61	Institutions (non-hospital) Event Form
MEPS-HC Core Interview	26, 1, 11, 2, 46, 29, 3, 4, 5, 6, 7, 8, 9, 10, 12, 13, 14, 15, 16, 17, 18, 19, 20, 42, 43, 44, 45, 21, 31, 32, 33, 34, 35, 36, 22, 23, 24, 25, 27, 28, 30, 37, 38, 39, 40, 41	Access to Care ,   Additional Health Questions ,   Assets ,   Calendar Section ,   Closing Section ,   Contacting Module Section ,   Charge Payment Section ,   Child Preventive Health Section ,   Dental Visit Section ,   Event Driver Section ,   Event Enumeration Section ,   Event Follow-Up Section ,   Employment Section ,   Employment Driver Section ,   Emergency Room Section ,   Event Roster Section ,   Employment Wages Section ,   Flat Fee Section ,   Food Security Section ,   Global Section ,   Health Status Section ,   Home Health Section ,   Health Insurance Detail Section ,   Time Period Covered Detail Section ,   Hospital Stay Section ,   Health Insurance Section ,   Institutional Care Stay Section ,   Income Section ,   Institutional Care Section ,   Medical Visit Section ,   Old Employment-Private Related Insurance Section ,   Off Path Navigation Section ,   Other Medical Expenses Section ,   Outpatient Department Section ,   Priority Condition Section ,   Prescribed Medicines Section ,   Provider Probes Section ,   Old Public Related Insurance Section ,   Provider Roster Section ,   Quality Supplement Section ,   Reenumeration A Section ,   Reenumeration B Section ,   Respondent Forms Section ,   Review of Employment Section ,   Start-Restart Section ,   Telehealth Section
MEPS-HC Validation Interview	54a, 54b	Validation Letter ,   Phone Validation Form
MPC Contact Guide/Screening Call	55	MPC Contact Guide & Screening Call
Office Based Providers Form	58	Office Based Provider Event Form
Pharmacies Event Form	62	Pharmacies Event Form
Preventive Care SAQ	49	PSAQ
Separately Billing Doctors Form	59	Separately Billing Doctors Event Form

---

ICR Summary of Burden

table that charts list of burden

	Total Request	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	384,693	642,279	0	-257,586	0	0
Annual Time Burden (Hours)	67,489	76,499	0	-9,010	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The changes in burden hours are due primarily to more accurate estimates in both the number of respondents and the time required for completing some of the forms.

---

Annual Cost to Federal Government: $64,851,222

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 07/02/2024

---