Medical Expenditure Panel Survey - Household and Medical Provider Components

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 46 Telehealth Section	Form and Instruction	Modified	Available
Form 45 Start-Restart Section	Form and Instruction	Modified	Available
Form 44 Review of Employment Section	Form and Instruction	Modified	Available
Form 43 Respondent Forms Section	Form and Instruction	Modified	Available
Form 42 Reenumeration B Section	Form and Instruction	Modified	Available
Form 41 Reenumeration A Section	Form and Instruction	Modified	Available
Form 40 Quality Supplement Section	Form and Instruction	Modified	Available
Form 39 Provider Roster Section	Form and Instruction	Modified	Available
Form 38 Old Public Related Insurance Section	Form and Instruction	Modified	Available
Form 37 Provider Probes Section	Form and Instruction	Modified	Available
Form 36 Prescribed Medicines Section	Form and Instruction	Modified	Available
Form 35 Priority Condition Section	Form and Instruction	Modified	Available
Form 34 Outpatient Department Section	Form and Instruction	Modified	Available
Form 33 Other Medical Expenses Section	Form and Instruction	Modified	Available
Form 32 Off Path Navigation Section	Form and Instruction	Modified	Available
Form 31 Old Employment-Private Related Insurance Section	Form and Instruction	Modified	Available
Form 30 Medical Visit Section	Form and Instruction	Modified	Available
Form 29 Institutional Care Section	Form and Instruction	Modified	Available
Form 28 Income Section	Form and Instruction	Modified	Available
Form 27 Institutional Care Stay Section	Form and Instruction	Modified	Available
Form 26 Health Insurance Section	Form and Instruction	Modified	Available
Form 25 Hospital Stay Section	Form and Instruction	Modified	Available
Form 24 Time Period Covered Detail Section	Form and Instruction	Modified	Available
Form 23 Health Insurance Detail Section	Form and Instruction	Modified	Available
Form 22 Home Health Section	Form and Instruction	Modified	Available
Form 21 Health Status Section	Form and Instruction	Modified	Available
Form 20 Global Section	Form and Instruction	Modified	Available
Form 19 Food Security Section	Form and Instruction	Modified	Available
Form 18 Flat Fee Section	Form and Instruction	Modified	Available
Form 17 Employment Wages Section	Form and Instruction	Modified	Available
Form 16 Event Roster Section	Form and Instruction	Modified	Available
Form 15 Emergency Room Section	Form and Instruction	Modified	Available
Form 14 Employment Driver Section	Form and Instruction	Modified	Available
Form 13 Employment Section	Form and Instruction	Modified	Available
Form 12 Event Follow-Up Section	Form and Instruction	Modified	Available
Form 11 Event Enumeration Section	Form and Instruction	Modified	Available
Form 10 Event Driver Section	Form and Instruction	Modified	Available
Form 9 Dental Visit Section	Form and Instruction	Modified	Available
Form 8 Child Preventive Health Section	Form and Instruction	Modified	Available
Form 7 Charge Payment Section	Form and Instruction	Modified	Available
Form 6 Contacting Module Section	Form and Instruction	Modified	Available
Form 5 Closing Section	Form and Instruction	Modified	Available
Form 4 Calendar Section	Form and Instruction	Modified	Available
Form 3 Assets	Form and Instruction	Modified	Available
Form 2 Additional Health Questions	Form and Instruction	Modified	Available
Form 1 Access to Care	Form and Instruction	Modified	Available
Form 1 MEPS-HC Core Interview	Form and Instruction	Modified	Repair queued
Form 63 Burdens and Economic Impacts of Medical Care SAQ	Form and Instruction	New	Available
Form 63 Burdens and Economic Impacts of Medical Care SAQ	Form and Instruction	New	Repair queued
Form 2a Cancer SAQ	Form and Instruction	Removed	Available
Form 2a Cancer SAQ	Form and Instruction	Removed	Repair queued
Form 49 PSAQ	Form and Instruction	Modified	Available
Form 49 Preventive Care SAQ	Form and Instruction	Modified	Repair queued
Form 48 Adult SAQ	Form and Instruction	Modified	Available
Form 48 Adult SAQ	Form and Instruction	Modified	Repair queued
Form 55 MPC Contact Guide & Screening Call	Form and Instruction	Modified	Available
Form 55 MPC Contact Guide/Screening Call	Form and Instruction	Modified	Repair queued
Form 54b Phone Validation Form	Form and Instruction	Modified	Available
Form 54a Validation Letter	Form and Instruction	Modified	Available
Form 54a MEPS-HC Validation Interview	Form and Instruction	Modified	Repair queued
Form 53 Permission Form for Pharmacies	Form and Instruction	Modified	Available
Form 52 Permission Form for Medical Providers	Form and Instruction	Modified	Available
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	Available
Form 62 Pharmacies Event Form	Form and Instruction	Modified	Repair queued
Form 61 Institutions (non-hospital) Event Form	Form and Instruction	Modified	Available
Form 61 Institutions (non-hospital) Event Form	Form and Instruction	Modified	Repair queued
Form 60 Hospital Event Form	Form and Instruction	Modified	Available
Form 60 Hospitals Event Form	Form and Instruction	Modified	Repair queued
Form 59 Separately Billing Doctors Event Form	Form and Instruction	Modified	Available
Form 59 Separately Billing Doctors Form	Form and Instruction	Modified	Repair queued
Form 58 Office Based Provider Event Form	Form and Instruction	Modified	Available
Form 58 Office Based Providers Form	Form and Instruction	Modified	Repair queued
Form 57 Home Healthcare for Non-healthcare Providers	Form and Instruction	Modified	Available
Form 56 Home Healthcare for Healthcare Providers	Form and Instruction	Modified	Available
Form 56 Home Care Providers Event Form	Form and Instruction	Modified	Repair queued
Form 50 Diabetes Care SAQ	Form and Instruction	Modified	Available
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	Telehealth Section
37877	MEPS-HC Core Interview	Form and Instruction	Modified	Start-Restart Section
37877	MEPS-HC Core Interview	Form and Instruction	Modified	Review of Employment Section
37877	MEPS-HC Core Interview	Form and Instruction	Modified	Respondent Forms Section
37877	MEPS-HC Core Interview	Form and Instruction	Modified	Reenumeration B Section
37877	MEPS-HC Core Interview	Form and Instruction	Modified	Reenumeration A Section
37877	MEPS-HC Core Interview	Form and Instruction	Modified	Quality Supplement Section
37877	MEPS-HC Core Interview	Form and Instruction	Modified	Provider Roster Section
37877	MEPS-HC Core Interview	Form and Instruction	Modified	Old Public Related Insurance Section
37877	MEPS-HC Core Interview	Form and Instruction	Modified	Provider Probes Section
37877	MEPS-HC Core Interview	Form and Instruction	Modified	Prescribed Medicines Section
37877	MEPS-HC Core Interview	Form and Instruction	Modified	Priority Condition Section
37877	MEPS-HC Core Interview	Form and Instruction	Modified	Outpatient Department Section
37877	MEPS-HC Core Interview	Form and Instruction	Modified	Other Medical Expenses Section
37877	MEPS-HC Core Interview	Form and Instruction	Modified	Off Path Navigation Section
37877	MEPS-HC Core Interview	Form and Instruction	Modified	Old Employment-Private Related Insurance Section
37877	MEPS-HC Core Interview	Form and Instruction	Modified	Medical Visit Section
37877	MEPS-HC Core Interview	Form and Instruction	Modified	Institutional Care Section
37877	MEPS-HC Core Interview	Form and Instruction	Modified	Income Section
37877	MEPS-HC Core Interview	Form and Instruction	Modified	Institutional Care Stay Section
37877	MEPS-HC Core Interview	Form and Instruction	Modified	Health Insurance Section
37877	MEPS-HC Core Interview	Form and Instruction	Modified	Hospital Stay Section
37877	MEPS-HC Core Interview	Form and Instruction	Modified	Time Period Covered Detail Section
37877	MEPS-HC Core Interview	Form and Instruction	Modified	Health Insurance Detail Section
37877	MEPS-HC Core Interview	Form and Instruction	Modified	Home Health Section
37877	MEPS-HC Core Interview	Form and Instruction	Modified	Health Status Section
37877	MEPS-HC Core Interview	Form and Instruction	Modified	Global Section
37877	MEPS-HC Core Interview	Form and Instruction	Modified	Food Security Section
37877	MEPS-HC Core Interview	Form and Instruction	Modified	Flat Fee Section
37877	MEPS-HC Core Interview	Form and Instruction	Modified	Employment Wages Section
37877	MEPS-HC Core Interview	Form and Instruction	Modified	Event Roster Section
37877	MEPS-HC Core Interview	Form and Instruction	Modified	Emergency Room Section
37877	MEPS-HC Core Interview	Form and Instruction	Modified	Employment Driver Section
37877	MEPS-HC Core Interview	Form and Instruction	Modified	Employment Section
37877	MEPS-HC Core Interview	Form and Instruction	Modified	Event Follow-Up Section
37877	MEPS-HC Core Interview	Form and Instruction	Modified	Event Enumeration Section
37877	MEPS-HC Core Interview	Form and Instruction	Modified	Event Driver Section
37877	MEPS-HC Core Interview	Form and Instruction	Modified	Dental Visit Section
37877	MEPS-HC Core Interview	Form and Instruction	Modified	Child Preventive Health Section
37877	MEPS-HC Core Interview	Form and Instruction	Modified	Charge Payment Section
37877	MEPS-HC Core Interview	Form and Instruction	Modified	Contacting Module Section
37877	MEPS-HC Core Interview	Form and Instruction	Modified	Closing Section
37877	MEPS-HC Core Interview	Form and Instruction	Modified	Calendar Section
37877	MEPS-HC Core Interview	Form and Instruction	Modified	Assets
37877	MEPS-HC Core Interview	Form and Instruction	Modified	Additional Health Questions
37877	MEPS-HC Core Interview	Form and Instruction	Modified	Access to Care
37877	MEPS-HC Core Interview	Form and Instruction	Modified
269113	Burdens and Economic Impacts of Medical Care SAQ	Form and Instruction	New	Burdens and Economic Impacts of Medical Care SAQ
269113	Burdens and Economic Impacts of Medical Care SAQ	Form and Instruction	New
264332	Cancer SAQ	Form and Instruction	Removed	Cancer SAQ
264332	Cancer SAQ	Form and Instruction	Removed
264315	Preventive Care SAQ	Form and Instruction	Modified	PSAQ
264315	Preventive Care SAQ	Form and Instruction	Modified
264201	Adult SAQ	Form and Instruction	Modified	Adult SAQ
264201	Adult SAQ	Form and Instruction	Modified
204200	MPC Contact Guide/Screening Call	Form and Instruction	Modified	MPC Contact Guide & Screening Call
204200	MPC Contact Guide/Screening Call	Form and Instruction	Modified
204199	MEPS-HC Validation Interview	Form and Instruction	Modified	Phone Validation Form
204199	MEPS-HC Validation Interview	Form and Instruction	Modified	Validation Letter
204199	MEPS-HC Validation Interview	Form and Instruction	Modified
204197	Authorization Form for the MEPS-MPC Provider and Pharmacy Survey	Form and Instruction	Modified	Permission Form for Pharmacies
204197	Authorization Form for the MEPS-MPC Provider and Pharmacy Survey	Form and Instruction	Modified	Permission Form for Medical Providers
204197	Authorization Form for the MEPS-MPC Provider and Pharmacy Survey	Form and Instruction	Modified
191107	Pharmacies Event Form	Form and Instruction	Modified	Pharmacies Event Form
191107	Pharmacies Event Form	Form and Instruction	Modified
191106	Institutions (non-hospital) Event Form	Form and Instruction	Modified	Institutions (non-hospital) Event Form
191106	Institutions (non-hospital) Event Form	Form and Instruction	Modified
191105	Hospitals Event Form	Form and Instruction	Modified	Hospital Event Form
191105	Hospitals Event Form	Form and Instruction	Modified
191104	Separately Billing Doctors Form	Form and Instruction	Modified	Separately Billing Doctors Event Form
191104	Separately Billing Doctors Form	Form and Instruction	Modified
191103	Office Based Providers Form	Form and Instruction	Modified	Office Based Provider Event Form
191103	Office Based Providers Form	Form and Instruction	Modified
191101	Home Care Providers Event Form	Form and Instruction	Modified	Home Healthcare for Non-healthcare Providers
191101	Home Care Providers Event Form	Form and Instruction	Modified	Home Healthcare for Healthcare Providers
191101	Home Care Providers Event Form	Form and Instruction	Modified
191099	Diabetes Care SAQ	Form and Instruction	Modified	Diabetes Care SAQ
191099	Diabetes Care SAQ	Form and Instruction	Modified

ICR Details

OMB Control No: 0935-0118	ICR Reference No: 202406-0935-002
Status: Historical Active	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
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/10/2024
Retrieve Notice of Action (NOA)	Date Received in OIRA: 07/02/2024
Terms of Clearance: OMB is approving this information collection request for a period of two years. CMS must update all race and ethnicity questions to comply with SPD15 before a renewal in 2026, as the National Health Interview Survey is updated.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2026	36 Months From Approved	03/31/2027
Responses	384,693	0	642,279
Time Burden (Hours)	67,489	0	76,499
Cost Burden (Dollars)	0	0	0

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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).

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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

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

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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

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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, 21, 22, 23, 24, 25, 27, 28, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45	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

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ICR Summary of Burden

table that charts list of burden

	Total Approved	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.

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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

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Common Form ICR:  No

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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

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