MEPS-HC Core Interview

Medical Expenditure Panel Survey - Household and Medical Provider Components

OMB: 0935-0118

IC ID: 37877

Documents and Forms

Document Name Document Type
Form 1 MEPS-HC Core Interview Form and Instruction
1 Access to Care Attachment 1 -- Access to Care.pdf Form and Instruction
1 Access to Care Attachment 1 -- Access to Care.pdf Form and Instruction
2 Additional Health Questions Attachment 2 -- Additional Healthcare Questions.pdf Form and Instruction
2 Additional Health Questions Attachment 2 -- Additional Healthcare Questions.pdf Form and Instruction
3 Assets Attachment 3 -- Assets.pdf Form and Instruction
3 Assets Attachment 3 -- Assets.pdf Form and Instruction
4 Calendar Section Attachment 4 -- Calendar Section.pdf Form and Instruction
4 Calendar Section Attachment 4 -- Calendar Section.pdf Form and Instruction
5 Closing Section Attachment 5 -- Closing Section.pdf Form and Instruction
5 Closing Section Attachment 5 -- Closing Section.pdf Form and Instruction
6 Contacting Module Section Attachment 6 -- Contacting Module Section.pdf Form and Instruction
6 Contacting Module Section Attachment 6 -- Contacting Module Section.pdf Form and Instruction
7 Charge Payment Section Attachment 7 -- Charge Payment Section.pdf Form and Instruction
7 Charge Payment Section Attachment 7 -- Charge Payment Section.pdf Form and Instruction
8 Child Preventive Health Section Attachment 8 -- Child Preventive Health Section.pdf Form and Instruction
8 Child Preventive Health Section Attachment 8 -- Child Preventive Health Section.pdf Form and Instruction
9 Dental Visit Section Attachment 9 -- Dental Visit Section.pdf Form and Instruction
9 Dental Visit Section Attachment 9 -- Dental Visit Section.pdf Form and Instruction
10 Event Driver Section Attachment 10 -- Event Driver Section.pdf Form and Instruction
10 Event Driver Section Attachment 10 -- Event Driver Section.pdf Form and Instruction
11 Event Enumeration Section Attachment 11 -- Event Enumeration Section.pdf Form and Instruction
11 Event Enumeration Section Attachment 11 -- Event Enumeration Section.pdf Form and Instruction
12 Event Follow-Up Section Attachment 12 -- Event Follow-Up Section.pdf Form and Instruction
12 Event Follow-Up Section Attachment 12 -- Event Follow-Up Section.pdf Form and Instruction
13 Employment Section Attachment 13 -- Employment Section.pdf Form and Instruction
13 Employment Section Attachment 13 -- Employment Section.pdf Form and Instruction
14 Employment Driver Section Attachment 14 -- Employment Driver Section.pdf Form and Instruction
14 Employment Driver Section Attachment 14 -- Employment Driver Section.pdf Form and Instruction
15 Emergency Room Section Attachment 15 -- Emergency Room Section.pdf Form and Instruction
15 Emergency Room Section Attachment 15 -- Emergency Room Section.pdf Form and Instruction
16 Event Roster Section Attachment 16 -- Event Roster Section.pdf Form and Instruction
16 Event Roster Section Attachment 16 -- Event Roster Section.pdf Form and Instruction
17 Employment Wages Section Attachment 17 -- Employment Wages Section.pdf Form and Instruction
17 Employment Wages Section Attachment 17 -- Employment Wages Section.pdf Form and Instruction
18 Flat Fee Section Attachment 18 -- Flat Fee Section.pdf Form and Instruction
18 Flat Fee Section Attachment 18 -- Flat Fee Section.pdf Form and Instruction
19 Food Security Section Attachment 19 -- Food Security Section.pdf Form and Instruction
19 Food Security Section Attachment 19 -- Food Security Section.pdf Form and Instruction
20 Global Section Attachment 20 -- Global Section.pdf Form and Instruction
20 Global Section Attachment 20 -- Global Section.pdf Form and Instruction
21 Health Status Section Attachment 21 - Health Status Section.pdf Form and Instruction
21 Health Status Section Attachment 21 - Health Status Section.pdf Form and Instruction
22 Home Health Section Attachment 22 -- Home Health Section.pdf Form and Instruction
22 Home Health Section Attachment 22 -- Home Health Section.pdf Form and Instruction
23 Health Insurance Detail Section Attachment 23 -- Health Insurance Detail Section.pdf Form and Instruction
23 Health Insurance Detail Section Attachment 23 -- Health Insurance Detail Section.pdf Form and Instruction
24 Time Period Covered Detail Section Attachment 24 -- Time Period Covered Detail Section.pdf Form and Instruction
24 Time Period Covered Detail Section Attachment 24 -- Time Period Covered Detail Section.pdf Form and Instruction
25 Hospital Stay Section Attachment 25 -- Hospital Stay Section.pdf Form and Instruction
25 Hospital Stay Section Attachment 25 -- Hospital Stay Section.pdf Form and Instruction
26 Health Insurance Section Attachment 26 -- Health Insurance Section.pdf Form and Instruction
26 Health Insurance Section Attachment 26 -- Health Insurance Section.pdf Form and Instruction
27 Institutional Care Stay Section Attachment 27 -- Institutional Care Stay Section.pdf Form and Instruction
27 Institutional Care Stay Section Attachment 27 -- Institutional Care Stay Section.pdf Form and Instruction
28 Income Section Attachment 28 -- Income Section.pdf Form and Instruction
28 Income Section Attachment 28 -- Income Section.pdf Form and Instruction
29 Institutional Care Section Attachment 29 -- Institutional Care Section.pdf Form and Instruction
29 Institutional Care Section Attachment 29 -- Institutional Care Section.pdf Form and Instruction
30 Medical Visit Section Attachment 30 -- Medical Visit Section.pdf Form and Instruction
30 Medical Visit Section Attachment 30 -- Medical Visit Section.pdf Form and Instruction
31 Old Employment-Private Related Insurance Section Attachment 31 -- Old Empl-Priv Related Ins Section.pdf Form and Instruction
31 Old Employment-Private Related Insurance Section Attachment 31 -- Old Empl-Priv Related Ins Section.pdf Form and Instruction
32 Off Path Navigation Section Attachment 32 -- Off Path Navigation Section.pdf Form and Instruction
32 Off Path Navigation Section Attachment 32 -- Off Path Navigation Section.pdf Form and Instruction
33 Other Medical Expenses Section Attachment 33 -- Other Medical Expenses Section.pdf Form and Instruction
33 Other Medical Expenses Section Attachment 33 -- Other Medical Expenses Section.pdf Form and Instruction
34 Outpatient Department Section Attachment 34 -- Outpatient Department Section.pdf Form and Instruction
34 Outpatient Department Section Attachment 34 -- Outpatient Department Section.pdf Form and Instruction
35 Priority Condition Section Attachment 35 -- Priority Condition Enumeration Section.pdf Form and Instruction
35 Priority Condition Section Attachment 35 -- Priority Condition Enumeration Section.pdf Form and Instruction
36 Prescribed Medicines Section Attachment 36 -- Prescribed Medicines Section.pdf Form and Instruction
36 Prescribed Medicines Section Attachment 36 -- Prescribed Medicines Section.pdf Form and Instruction
37 Provider Probes Section Attachment 37 -- Provider Probes Section.pdf Form and Instruction
37 Provider Probes Section Attachment 37 -- Provider Probes Section.pdf Form and Instruction
38 Old Public Related Insurance Section Attachment 38 -- Old Public Related Insurance Section.pdf Form and Instruction
38 Old Public Related Insurance Section Attachment 38 -- Old Public Related Insurance Section.pdf Form and Instruction
39 Provider Roster Section Attachment 39 -- Provider Roster Section.pdf Form and Instruction
39 Provider Roster Section Attachment 39 -- Provider Roster Section.pdf Form and Instruction
40 Quality Supplement Section Attachment 40 -- Quality Supplement Section.pdf Form and Instruction
40 Quality Supplement Section Attachment 40 -- Quality Supplement Section.pdf Form and Instruction
41 Reenumeration A Section Attachment 41 -- Reenumeration A Section.pdf Form and Instruction
41 Reenumeration A Section Attachment 41 -- Reenumeration A Section.pdf Form and Instruction
42 Reenumeration B Section Attachment 42 -- Reenumeration B Section.pdf Form and Instruction
42 Reenumeration B Section Attachment 42 -- Reenumeration B Section.pdf Form and Instruction
43 Respondent Forms Section Attachment 43 -- Respondent Forms Section.pdf Form and Instruction
43 Respondent Forms Section Attachment 43 -- Respondent Forms Section.pdf Form and Instruction
44 Review of Employment Section Attachment 44 -- Review of Employment Section.pdf Form and Instruction
44 Review of Employment Section Attachment 44 -- Review of Employment Section.pdf Form and Instruction
45 Start-Restart Section Attachment 45 -- Start-Restart Section.pdf Form and Instruction
45 Start-Restart Section Attachment 45 -- Start-Restart Section.pdf Form and Instruction
46 Telehealth Section Attachment 46 -- Telehealth Section.pdf Form and Instruction
46 Telehealth Section Attachment 46 -- Telehealth Section.pdf Form and Instruction
Attachment 47 - MEPS-HC Show Cards.pdf MEPS-HC Show Cards IC Document
Attachment 47 - MEPS-HC Show Cards.pdf MEPS-HC Show Cards IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	MEPS-HC Core Interview	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Access to Care	Attachment 1 -- Access to Care.pdf	No		Fillable Fileable
Form and Instruction	2	Additional Health Questions	Attachment 2 -- Additional Healthcare Questions.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	3	Assets	Attachment 3 -- Assets.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	4	Calendar Section	Attachment 4 -- Calendar Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	5	Closing Section	Attachment 5 -- Closing Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	6	Contacting Module Section	Attachment 6 -- Contacting Module Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	7	Charge Payment Section	Attachment 7 -- Charge Payment Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	8	Child Preventive Health Section	Attachment 8 -- Child Preventive Health Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	9	Dental Visit Section	Attachment 9 -- Dental Visit Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	10	Event Driver Section	Attachment 10 -- Event Driver Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	11	Event Enumeration Section	Attachment 11 -- Event Enumeration Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	12	Event Follow-Up Section	Attachment 12 -- Event Follow-Up Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	13	Employment Section	Attachment 13 -- Employment Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	14	Employment Driver Section	Attachment 14 -- Employment Driver Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	15	Emergency Room Section	Attachment 15 -- Emergency Room Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	16	Event Roster Section	Attachment 16 -- Event Roster Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	17	Employment Wages Section	Attachment 17 -- Employment Wages Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	18	Flat Fee Section	Attachment 18 -- Flat Fee Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	19	Food Security Section	Attachment 19 -- Food Security Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	20	Global Section	Attachment 20 -- Global Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	21	Health Status Section	Attachment 21 - Health Status Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	22	Home Health Section	Attachment 22 -- Home Health Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	23	Health Insurance Detail Section	Attachment 23 -- Health Insurance Detail Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	24	Time Period Covered Detail Section	Attachment 24 -- Time Period Covered Detail Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	25	Hospital Stay Section	Attachment 25 -- Hospital Stay Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	26	Health Insurance Section	Attachment 26 -- Health Insurance Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	27	Institutional Care Stay Section	Attachment 27 -- Institutional Care Stay Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	28	Income Section	Attachment 28 -- Income Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	29	Institutional Care Section	Attachment 29 -- Institutional Care Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	30	Medical Visit Section	Attachment 30 -- Medical Visit Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	31	Old Employment-Private Related Insurance Section	Attachment 31 -- Old Empl-Priv Related Ins Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	32	Off Path Navigation Section	Attachment 32 -- Off Path Navigation Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	33	Other Medical Expenses Section	Attachment 33 -- Other Medical Expenses Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	34	Outpatient Department Section	Attachment 34 -- Outpatient Department Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	35	Priority Condition Section	Attachment 35 -- Priority Condition Enumeration Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	36	Prescribed Medicines Section	Attachment 36 -- Prescribed Medicines Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	37	Provider Probes Section	Attachment 37 -- Provider Probes Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	38	Old Public Related Insurance Section	Attachment 38 -- Old Public Related Insurance Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	39	Provider Roster Section	Attachment 39 -- Provider Roster Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	40	Quality Supplement Section	Attachment 40 -- Quality Supplement Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	41	Reenumeration A Section	Attachment 41 -- Reenumeration A Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	42	Reenumeration B Section	Attachment 42 -- Reenumeration B Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	43	Respondent Forms Section	Attachment 43 -- Respondent Forms Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	44	Review of Employment Section	Attachment 44 -- Review of Employment Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	45	Start-Restart Section	Attachment 45 -- Start-Restart Section.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	46	Telehealth Section	Attachment 46 -- Telehealth Section.pdf	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 12,683	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	31,708	2,333	29,375
Annual IC Time Burden (Hours)	46,505	3,422	43,083
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
MEPS-HC Show Cards	Attachment 47 - MEPS-HC Show Cards.pdf	07/01/2024

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