Medical Expenditure Panel Survey - Household and Medical Provider Components

ICR 202406-0935-002

OMB: 0935-0118

Federal Form Document

Forms and Documents

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

IC Document Collections

IC ID	Document Title	Status
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