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Authorization Form for the MEPS-MPC Provider and Pharmacy Survey
Medical Expenditure Panel Survey - Household and Medical Provider Components
OMB: 0935-0118
IC ID: 204197
OMB.report
HHS/AHRQ
OMB 0935-0118
ICR 202406-0935-002
IC 204197
( )
Documents and Forms
Document Name
Document Type
Form 52
Authorization Form for the MEPS-MPC Provider and Pharmacy Survey
Form and Instruction
52 Permission Form for Medical Providers
Attachment 52 -- Permission Form for Medical Providers.pdf
Form and Instruction
53 Permission Form for Pharmacies
Attachment 53 -- Permission Form for Pharmicies.pdf
Form and Instruction
Information Collection (IC) Details
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