Medical Expenditure Panel Survey - Household and Medical Provider Components

OMB 0935-0118

The purpose of this request is to integrate several items into MEPS including several new questions related to COVID-19 (Attachment A) including telehealth (telemedicine) questions (Attachment B) into the CAPI questionnaire and a new self-administered questionnaire (SAQ) entitled, “Social and Health Experiences,” (see Attachment C). The questions on COVID-19 capture information on any delay in care due to COVID-19. The questions will be administered through an RU level gate question with follow up questions asked at the person level as appropriate. Telehealth (telemedicine) will be administered as its own event type with questions and probes mirroring those used for in-person medical provider visits. The Social and Health Experiences SAQ will include questions in a dual mode (web and paper) self-administered questionnaire about social and behavioral determinants of health including questions about housing affordability and quality, neighborhood characteristics, food security, transportation needs, financial strain, smoking and physical activity, and experiences with discrimination, social support, general well-being, personal safety, and adverse circumstances in childhood. Data collection will be for eligible adults (aged 18 and over). AHRQ proposes a mixed-mode (web and paper) primarily to further protect respondent’s privacy due to the sensitive nature of some of the items. Web completion will be the main mode with paper offered to those with barriers to internet access. In addition, due to COVID-19, in March of 2020, MEPS moved to telephone interviewing for all panels and rounds currently in the field with increased use of the web to facilitate respondent reporting; for example the use of showcards. The current plan is resume at least some face-to-face interviewing during the fall rounds for Panels 23, 24, and 25. Moreover, Panels 23 and 24 are to be extended one year with the creation of Round 6 and 7 interviews in order to contribute to the data collected for data years 2020 and 2021. The data collected will offset any impact on response rates due to the pandemic or changes in primary mode for data collection.

The latest form for Medical Expenditure Panel Survey - Household and Medical Provider Components expires 2023-11-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form 2a Cancer SAQ Form and Instruction
Form 5a Preventive Care SAQ Form and Instruction
Form 1a Adult SAQ Form and Instruction
Form 1 COVID-19 Questions Form and Instruction
Form Attachment A – COV COVID-19 and Telehealth (telemedicine) questions included in the MEPS questionnaire Form and Instruction
Form Attachment C Attachment C – Social and Health Experiences Self-Administered Questionnaire Form and Instruction
Form 106a HC Adult SAQ that includes Mental Health Questions Form and Instruction
Form 107a Health Insurance Cost Sharing Collection- 2020 Form and Instruction
Form 108 Pilot Test on Sampling NHIS Nonrespondents – 2020, R1 only of MEPS Core Form and Instruction
Form Attachment 19 Attachment 19 – HC Adult SAQ – Male Form and Instruction
Form Attachment 20 Attachment 20 HC Adult SAQ Female Form and Instruction
Form Attachment 72 MPC Contact Guide/Screening Call Form and Instruction
Form Attachment 26 MEPS-HC Validation Interview Form and Instruction
Form Attachment 24 Authorization form for the MEPS-MPC Pharmacy Survey Form and Instruction
Form Attachment 25 Authorization form for the MEPS-MPC Provider and Pharmacy Survey Form and Instruction
Form Attachment 98 Pharmacies questionnaire Form and Instruction
Form Attachment 96 Institutions (non-hospital) questionnaire Form and Instruction
Form Attachment 91 Hospitals questionnaire Form and Instruction
Form Attachment 87 Separately billing doctors questionnaire Form and Instruction
Form Attachment 83 Office based providers questionnaire Form and Instruction
Form Attachment 82 Home care for non health care providers questionnaire Form and Instruction
Form 4a Home Care Providers Event Form Form and Instruction
Form Attachment 22 Diabetes Care SAQ Form and Instruction
SS Part A - MEPS-HC MPC 01122024.docx Supporting Statement A
SS Part B - MEPS HC MPC - 2024.docx Supporting Statement B
Attachment 6 - Federal Register Notice.pdf Supplementary Document
MEPS-HC Core Interview Other-Explanatory
Cancer SAQ Form and Instruction
Preventive Care SAQ Form and Instruction
Adult SAQ Form and Instruction
COVID-19 Questions Form and Instruction
COVID-19 and Telehealth (telemedicine) questions included in the MEPS questionnaire Form and Instruction
Attachment C – Social and Health Experiences Self-Administered Questionnaire Form and Instruction
HC Adult SAQ that includes Mental Health Questions Form and Instruction
Health Insurance Cost Sharing Collection- 2020 Form and Instruction
Pilot Test on Sampling NHIS Nonrespondents – 2020, R1 only of MEPS Core Form and Instruction
Attachment 19 – HC Adult SAQ – Male Form and Instruction
Attachment 20 HC Adult SAQ Female Form and Instruction
MPC Contact Guide/Screening Call Form and Instruction
MEPS-HC Validation Interview Form and Instruction
Authorization form for the MEPS-MPC Pharmacy Survey Form and Instruction
Authorization form for the MEPS-MPC Provider and Pharmacy Survey Form and Instruction
Pharmacies questionnaire Form and Instruction
Institutions (non-hospital) questionnaire Form and Instruction
Hospitals questionnaire Form and Instruction
Separately billing doctors questionnaire Form and Instruction
Office based providers questionnaire Form and Instruction
Home care for non health care providers questionnaire Form and Instruction
Home Care Providers Event Form Form and Instruction
Diabetes Care SAQ Form and Instruction

All Historical Document Collections

202401-0935-001 Approved with change	Revision of a currently approved collection	2024-01-12
202209-0935-003 Approved with change	Revision of a currently approved collection	2022-10-05
202007-0935-001 Approved with change	Revision of a currently approved collection	2020-08-04
201907-0935-002 Approved with change	Revision of a currently approved collection	2019-07-16
201808-0935-001 Approved with change	Revision of a currently approved collection	2018-09-14
201802-0935-002 Approved with change	Revision of a currently approved collection	2018-02-27
201509-0935-001 Approved with change	Revision of a currently approved collection	2015-09-15
201412-0935-002 Approved with change	Revision of a currently approved collection	2014-12-23
201209-0935-001 Approved without change	Extension without change of a currently approved collection	2012-09-25
201201-0935-001 Approved with change	Revision of a currently approved collection	2012-01-12
200910-0935-001 Approved with change	Extension without change of a currently approved collection	2009-10-23
200609-0935-001 Approved with change	Revision of a currently approved collection	2006-09-28
200605-0935-001 Approved without change	No material or nonsubstantive change to a currently approved collection	2006-05-30
200401-0935-001 Approved with change	New collection (Request for a new OMB Control Number)	2004-01-08

OMB Details

MEPS-HC Core Interview

Federal Enterprise Architecture: Health - Health Care Services

Form Attachment 32	Attachment 32 – Attachment 32 HC Calendar Section	Fillable Fileable	Form and instruction
Form Attachment 45	Attachment 45 – HC Employment Wage (EW) Section	Fillable Fileable	Form and instruction
Form Attachment 71	Attachment 71 HC Event Follow Up Section	Fillable Fileable	Form and instruction
Form Attachment 70	Attachment 70 HC RU Information Screener	Fillable Fileable	Form and instruction
Form Attachment 69	Attachment 69 HC Reenumeration Subsection B	Fillable Fileable	Form and instruction
Form Attachment 68	Attachment 68 HC Reenumeration Subsection	Fillable Fileable	Form and instruction
Form Attachment 67	Attachment 67 HC Provider Roster Section	Fillable Fileable	Form and instruction
Form Attachment 38	Attachment 38 – HC Child Preventive Health Supplement Section	Fillable Fileable	Form and instruction
Form Attachment 66	Attachment 66 HC Provider Probes Section	Fillable Fileable	Form and instruction
Form Attachment 65	Attachment 65 HC Prescribed Medicines Section	Fillable Fileable	Form and instruction
Form Attachment 64	Attachment 64 HC Priority Conditions Enumeration Section	Fillable Fileable	Form and instruction
Form Attachment 63	Attachment 63 HC Respondent Forms Section	Fillable Fileable	Form and instruction
Form Attachment 62	Attachment 62 HC Quality Supplement Section	Fillable Fileable	Form and instruction
Form Attachment 61	Attachment 61 HC Outpatient Department Section	Fillable Fileable	Form and instruction
Form Attachment 31	Attachment 31 – Attachment 31 HC Assets Section.	Fillable Fileable	Form and instruction
Form Attachment 30	Attachment 30 – HC Condition Enumeration Section	Fillable Fileable	Form and instruction
Form Attachment 29	Attachment 29 –HC Access to Care Section	Fillable Fileable	Form and instruction
Form Attachment 56	Attachment 56 HC Old Public Related Insurance (PR) Section	Fillable Fileable	Form and instruction
Form Attachment 55	Attachment 55 HC Old Employment Health Insurance (OE) Section	Fillable Fileable	Form and instruction
Form Attachment 54	Attachment 54 HC Managed Care (MC) Section	Fillable Fileable	Form and instruction
Form Attachment 52 HC	Attachment 52 HC Private Health Insurance Detail (HP) Section	Fillable Fileable	Form and instruction
Form Attachment 53	Attachment 53 HC Time Covered Detail (HQ) Section	Fillable Fileable	Form and instruction
Form Attachment 51	Attachment 51 Health Insurance (HX) Section	Fillable Fileable	Form and instruction
Form Attachment 50	Attachment 50 Home Health Section	Fillable Fileable	Form and instruction
Form Attachment 49	Attachment 49 HC Help Text	Fillable Fileable	Form and instruction
Form Attachment 48	Attachment 48 Health Status Section	Fillable Fileable	Form and instruction
Form Attachment 47	Attachment 47 Event Roster Section	Fillable Fileable	Form and instruction
Form Attachment 46	Attachment 46 – HC Emergency Room Section	Fillable Fileable	Form and instruction
Form Attachment 44	Attachment 44 – HC Employment Driver (OE) Section	Fillable Fileable	Form and instruction
Form Attachment 60	Attachment 60 HC Other Medical Expense Section	Fillable Fileable	Form and instruction
Form Attachment 59	Attachment 59 HC Medical Provider Section	Fillable Fileable	Form and instruction
Form Attachment 58	Attachment 58 HC Income Section	Fillable Fileable	Form and instruction
Form Attachment 57	Attachment 57 HC Hospital Stay Section	Fillable Fileable	Form and instruction
Form Attachment 43	Attachment 43 – HC Review of Employment Information (RJ) Section	Fillable Fileable	Form and instruction
Form Attachment 42	Attachment 42 – HC Employment (EM) Section	Fillable Fileable	Form and instruction
Form Attachment 41	Attachment 41 – HC Event Driver Section	Fillable Fileable	Form and instruction
Form Attachment 40	Attachment 40 – HC Dental Care Section	Fillable Fileable	Form and instruction
Form Attachment 39	Attachment 39 – HC Institutional Care Section	Fillable Fileable	Form and instruction
Form Attachment 37	Attachment 37 HC Flat Fee Section	Fillable Fileable	Form and instruction
Form Attachment 36	Attachment 36 HC Charge Payment Section	Fillable Fileable	Form and instruction
Form Attachment 35	Attachment 35 HC Start_Restart	Fillable Fileable	Form and instruction
Form Attachment 34	Attachment 34 HC Closing Section	Fillable Fileable	Form and instruction
Form Attachment 33	Attachment 33 Additional healthcare Section	Fillable Fileable	Form and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.