Information Collection Request

Medical Expenditure Panel Survey - Insurance Component (MEPS-IC)

ICR 202506-0935-001 · OMB 0935-0110 · Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form Form #3 Plan Questionnaire Form and Instruction Modified Available
Form Form #3 Plan Questionnaire Form and Instruction Modified Repair queued
Form Form #2 Establishment Questionnaire Form and Instruction Modified Available
Form Form #2 Establishment Questionnaire Form and Instruction Modified Available
Form Form #1 Precanvass/Prescreener Questionnaire Form and Instruction Modified Available
Form Form #1 Prescreener Questionnaire Form and Instruction Modified Repair queued
Attachement O - Non-Response Bias Analysis of the 2022 MEPS-IC.pdf Supplementary Document Uploaded 2025-08-27 Available
Attachment Q - Initial Letter for Governments.pdf Supplementary Document Uploaded 2025-06-12 Available
Attachment Q - Initial Letter for Governments.pdf Supplementary Document Uploaded 2025-06-12 Repair queued
Attachment P - Initial Letter for Privates.pdf Supplementary Document Uploaded 2025-06-12 Available
Attachment P - Initial Letter for Privates.pdf Supplementary Document Uploaded 2025-06-12 Repair queued
Attachment O -- Non-Response Bias Analysis of the 2014 MEPS-IC.pdf Supplementary Document Uploaded 2025-06-12 Available
Attachment O -- Non-Response Bias Analysis of the 2014 MEPS-IC.pdf Supplementary Document Uploaded 2025-06-12 Repair queued
Attachment N - Definitions.pdf Supplementary Document Uploaded 2025-06-12 Available
Attachment N - Definitions.pdf Supplementary Document Uploaded 2025-06-12 Repair queued
Attachment M - Multi Unit Private Sector.pdf Supplementary Document Uploaded 2025-06-12 Available
Attachment M - Multi Unit Private Sector.pdf Supplementary Document Uploaded 2025-06-12 Repair queued
Attachment L - Single Unit Private Sector.pdf Supplementary Document Uploaded 2025-06-12 Repair queued
Attachment L - Single Unit Private Sector.pdf Supplementary Document Uploaded 2025-06-12 Repair queued
Attachment K- CMU Advance Letter.pdf Supplementary Document Uploaded 2025-06-12 Available
Attachment K- CMU Advance Letter.pdf Supplementary Document Uploaded 2025-06-12 Available
Attachment J - Certainty Government Initial Letter.pdf Supplementary Document Uploaded 2025-06-12 Repair queued
Attachment J - Certainty Government Initial Letter.pdf Supplementary Document Uploaded 2025-06-12 Repair queued
Attachment I - Certainty Government Advance Letter.pdf Supplementary Document Uploaded 2025-06-12 Available
Attachment I - Certainty Government Advance Letter.pdf Supplementary Document Uploaded 2025-06-12 Available
Attachment H -Non Certainty Government Initial Letter.pdf Supplementary Document Uploaded 2025-06-12 Available
Attachment H -Non Certainty Government Initial Letter.pdf Supplementary Document Uploaded 2025-06-12 Repair queued
Attachment G - Sample Strata 2025-2027.pdf Supplementary Document Uploaded 2025-06-12 Repair queued
Attachment G - Sample Strata 2025-2027.pdf Supplementary Document Uploaded 2025-06-12 Repair queued
Attachment F - Allocation by State 2025-2027.pdf Supplementary Document Uploaded 2025-06-12 Available
Attachment F - Allocation by State 2025-2027.pdf Supplementary Document Uploaded 2025-06-12 Repair queued
Attachment E -- Confidentiality Form.pdf Supplementary Document Uploaded 2025-06-12 Repair queued
Attachment E -- Confidentiality Form.pdf Supplementary Document Uploaded 2025-06-12 Repair queued
Attachment C - Plan Questionnaire.pdf Supplementary Document Uploaded 2025-06-12 Available
Attachment C - Plan Questionnaire.pdf Supplementary Document Uploaded 2025-06-12 Repair queued
Attachment D - 60 day FRN MEPS-IC 2025-2027.pdf Supplementary Document Uploaded 2025-06-12 Available
Attachment D - 60 day FRN MEPS-IC 2025-2027.pdf Supplementary Document Uploaded 2025-06-12 Repair queued
Attachment B -Establishment Questionnaire.pdf Supplementary Document Uploaded 2025-06-12 Available
Attachment B -Establishment Questionnaire.pdf Supplementary Document Uploaded 2025-06-12 Repair queued
Attachment A - Precanvass Questionnaire.pdf Supplementary Document Uploaded 2025-06-12 Available
Attachment A - Precanvass Questionnaire.pdf Supplementary Document Uploaded 2025-06-12 Missing upstream
SS Part B -- MEPS-IC 2023 - 2025 FINAL - OMB AHRQ Response Clean.docx Supporting Statement B Uploaded 2025-08-27 Available
SS Part B -- MEPS-IC 2023 - 2025 FINAL.docx Supporting Statement B Uploaded 2025-06-12 Repair queued
SS Part A -- MEPS-IC 2024 Extension FINAL 8 27 25.docx Supporting Statement A Uploaded 2025-08-27 Available
SS Part A -- MEPS-IC 2024 Extension FINAL.docx Supporting Statement A Uploaded 2025-06-12 Missing upstream
Attachment R - Public Comment.pdf Public Comments Uploaded 2024-12-14 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
182461 Plan Questionnaire Form and Instruction ModifiedPlan Questionnaire
182461 Plan Questionnaire Form and Instruction Modified
182460 Establishment Questionnaire Form and Instruction ModifiedEstablishment Questionnaire
182460 Establishment Questionnaire Form and Instruction Modified
182459 Prescreener Questionnaire Form and Instruction ModifiedPrecanvass/Prescreener Questionnaire
182459 Prescreener Questionnaire Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
08/31/2028 36 Months From Approved 01/31/2026
84,270 0 91,204
16,844 0 17,461
0 0 0





Reginfo record details
3
table that charts list of burden
IC Title Form No. Form Name
Establishment Questionnaire Form #2
Plan Questionnaire Form #3
Prescreener Questionnaire Form #1

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 84,270 91,204 0 -6,934 0 0
Annual Time Burden (Hours) 16,844 17,461 0 -617 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No