OMB control number

Medical Expenditure Panel Survey - Household and Medical Provider Components

OMB 0935-0118 · HHS/AHRQ.

OMB 0935-0118

The MEPS was initiated in 1996. Each year a new panel of sample households is selected. Recent annual MEPS-HC sample sizes average about 13,500 households. Data can be analyzed at either the person, family, or event level. The panel design of the survey, which includes 5 Rounds of interviews covering 2 full calendar years, provides data for examining person level changes in selected variables such as expenditures, health insurance coverage, and health status (see Medical Expenditure Panel Survey Content Summary of the Household Interview (ahrq.gov) for information on how the Covid-19 pandemic impacted this design). Using a combination of computer assisted personal interviewing (CAPI), computer assisted video interviewing (CAVI), and self-administered paper and web questionnaires, information about each household member is collected, and the survey builds on this information from interview to interview. CAVI is a new data collection technology and offers the best of both telephone and in-person interviewing, while offering opportunities for cost savings and more accurate reporting. This Information Collection Request (ICR) is for a revision to the Medical Expenditures Panel Survey – Household Component (MEPS-HC). These changes will be fielded in the Spring and Fall of 2025 and includes the addition of the Burdens and Economic Impacts of Medical Care Self-Administered Questionnaire (ESAQ), minor changes to questions in both the Core MEPS Interview and the Adult SAQ and removing the Cancer SAQ (CSAQ).

The latest form for Medical Expenditure Panel Survey - Household and Medical Provider Components expires 2029-06-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form 47 Telehealth Section Form and Instruction
Form 46 Start-Restart Section Form and Instruction
Form 45 Review of Employment Section Form and Instruction
Form 43 Reenumeration Section B Section Form and Instruction
Form 42 Renumeration A Section Form and Instruction
Form 41 Quality Supplement Section Form and Instruction
Form 40 Provider Roster Section Form and Instruction
Form 39 Old Public Related Insurance Section Form and Instruction
Form 38 Provider Probes Section Form and Instruction
Form 37 Prescribed Medicines Section Form and Instruction
Form 36 Priority Condition Enumeration Section Form and Instruction
Form 35 Outpatient Department Section Form and Instruction
Form 34 Other Medical Expenses Section Form and Instruction
Form 33 Off Path Navigation Section Form and Instruction
Form 32 Old Empl-Priv Related Ins Section Form and Instruction
Form 31 Medical Visit Section Form and Instruction
Form 30 Managed Care Section Form and Instruction
Form 29 Income Section Form and Instruction
Form 28 Institutional Care Stay Section Form and Instruction
Form 27 Health Insurance Section Form and Instruction
Form 26 Hospital Stay Section Form and Instruction
Form 25 Time Period Covered Detail Section Form and Instruction
Form 24 Health Insurance Detail Section Form and Instruction
Form 23 Home Health Section Form and Instruction
Form 22 Health Status Section Form and Instruction
Form 21 Global Section Form and Instruction
Form 20 Financial Well Being Section Form and Instruction
Form 19 Food Security Section Form and Instruction
Form 18 Flat Fee Section Form and Instruction
Form 17 Employment Wages Section Form and Instruction
Form 16 Event Roster Section Form and Instruction
Form 15 Emergency Room Section Form and Instruction
Form 14 Employment Driver Section Form and Instruction
Form 13 Employment Section Form and Instruction
Form 12 Event Follow Up Section Form and Instruction
Form 11 Event Enumeration Section Form and Instruction
Form 10 Event Driver Section Form and Instruction
Form 9 Dental Visit Section Form and Instruction
Form 8 Child Preventive Health Section Form and Instruction
Form 7 Charge Payment Section Form and Instruction
Form 6 Contracting Module Form and Instruction
Form 5 Closing Section Form and Instruction
Form 4 Calendar Section Form and Instruction
Form 3 Assets Form and Instruction
Form 2 Additional Questions Form and Instruction
Form 1 Access to Care Form and Instruction
Form 63 Burdens and Economic Impacts of Medical Care SAQ Form and Instruction
Form 50 PSAQ Form and Instruction
Form 49 Adult SAQ Form and Instruction
Form 54 MPC Contact Guide and Screening Call Form and Instruction
Form 53a Validation Letter Form and Instruction
Form 53b Phone Validation Form Form and Instruction
Form 52 Permission Form for Pharmacies Form and Instruction
Form 51 Permission Form for Medical Providers Form and Instruction
Form 61 Pharmacies Event Form Form and Instruction
Form 60 Institutions (non-hospital) Event Form Form and Instruction
Form 59 Hospital Event Form Form and Instruction
Form 58 Separately Billing Doctors Event Form Form and Instruction
Form 57 Office Based Provider Form Form and Instruction
Form 56 Home Healthcare for Non-healthcare Providers Form and Instruction
Form 55 Home Healthcare for Healthcare Providers Event Form Form and Instruction
Form 50 Diabetes Care SAQ Form and Instruction
Supporting Statement Part B_MEPS-HC-MPC_2026 Final 02202026.docx Supporting Statement B
Supporting Statement Part A_MEPS-HC-MPC_2026 Final 20260312 CLEAN.docx Supporting Statement A
Attachment A Data Security Plan.pdf Supplementary Document
MEPS-HC Core Interview Form and Instruction
MEPS-HC Core Interview Form and Instruction
MEPS-HC Core Interview Form and Instruction
MEPS-HC Core Interview Form and Instruction
MEPS-HC Core Interview Form and Instruction
MEPS-HC Core Interview Form and Instruction
MEPS-HC Core Interview Form and Instruction
MEPS-HC Core Interview Form and Instruction
MEPS-HC Core Interview Form and Instruction
MEPS-HC Core Interview Form and Instruction
MEPS-HC Core Interview Form and Instruction
MEPS-HC Core Interview Form and Instruction
MEPS-HC Core Interview Form and Instruction
MEPS-HC Core Interview Form and Instruction
MEPS-HC Core Interview Form and Instruction
MEPS-HC Core Interview Form and Instruction
MEPS-HC Core Interview Form and Instruction
MEPS-HC Core Interview Form and Instruction
MEPS-HC Core Interview Form and Instruction
MEPS-HC Core Interview Form and Instruction
MEPS-HC Core Interview Form and Instruction
MEPS-HC Core Interview Form and Instruction
MEPS-HC Core Interview Form and Instruction
MEPS-HC Core Interview Form and Instruction
MEPS-HC Core Interview Form and Instruction
MEPS-HC Core Interview Form and Instruction
MEPS-HC Core Interview Form and Instruction
MEPS-HC Core Interview Form and Instruction
MEPS-HC Core Interview Form and Instruction
MEPS-HC Core Interview Form and Instruction
MEPS-HC Core Interview Form and Instruction
MEPS-HC Core Interview Form and Instruction
MEPS-HC Core Interview Form and Instruction
MEPS-HC Core Interview Form and Instruction
MEPS-HC Core Interview Form and Instruction
MEPS-HC Core Interview Form and Instruction
MEPS-HC Core Interview Form and Instruction
MEPS-HC Core Interview Form and Instruction
MEPS-HC Core Interview Form and Instruction
MEPS-HC Core Interview Form and Instruction
MEPS-HC Core Interview Form and Instruction
MEPS-HC Core Interview Form and Instruction
MEPS-HC Core Interview Form and Instruction
MEPS-HC Core Interview Form and Instruction
MEPS-HC Core Interview Form and Instruction
MEPS-HC Core Interview Form and Instruction
Burdens and Economic Impacts of Medical Care SAQ Form and Instruction
Preventive Care SAQ Form and Instruction
Adult SAQ Form and Instruction
MPC Contact Guide/Screening Call Form and Instruction
MEPS-HC Validation Interview Form and Instruction
MEPS-HC Validation Interview Form and Instruction
Authorization Form for the MEPS-MPC Provider and Pharmacy Survey Form and Instruction
Authorization Form for the MEPS-MPC Provider and Pharmacy Survey Form and Instruction
Pharmacies Event Form Form and Instruction
Institutions (non-hospital) Event Form Form and Instruction
Hospitals Event Form Form and Instruction
Separately Billing Doctors Form Form and Instruction
Office Based Providers Form Form and Instruction
Home Health Care Providers Event Form Form and Instruction
Home Health Care Providers Event Form Form and Instruction
Diabetes Care SAQ Form and Instruction

All Historical Document Collections

202603-0935-001	Revision of a currently approved collection	2026-04-01
202406-0935-002 Approved without change	Revision of a currently approved collection	2024-07-02
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 7	Charge Payment Section	Fillable Fileable	Form and instruction
Form 4	Calendar Section	Fillable Fileable	Form and instruction
Form 1	Access to Care	Fillable Fileable	Form and instruction
Form 47	Telehealth Section	Fillable Fileable	Form and instruction
Form 37	Prescribed Medicines Section	Fillable Fileable	Form and instruction
Form 36	Priority Condition Enumeration Section	Fillable Fileable	Form and instruction
Form 15	Emergency Room Section	Fillable Fileable	Form and instruction
Form 2	Additional Questions	Fillable Fileable	Form and instruction
Form 38	Provider Probes Section	Fillable Fileable	Form and instruction
Form 20	Financial Well Being Section	Fillable Fileable	Form and instruction
Form 43	Reenumeration Section B Section	Fillable Fileable	Form and instruction
Form 42	Renumeration A Section	Fillable Fileable	Form and instruction
Form 41	Quality Supplement Section	Fillable Fileable	Form and instruction
Form 40	Provider Roster Section	Fillable Fileable	Form and instruction
Form 39	Old Public Related Insurance Section	Fillable Fileable	Form and instruction
Form 17	Employment Wages Section	Fillable Fileable	Form and instruction
Form 16	Event Roster Section	Fillable Fileable	Form and instruction
Form 34	Other Medical Expenses Section	Fillable Fileable	Form and instruction
Form 19	Food Security Section	Fillable Fileable	Form and instruction
Form 46	Start-Restart Section	Fillable Fileable	Form and instruction
Form 45	Review of Employment Section	Fillable Fileable	Form and instruction
Form 33	Off Path Navigation Section	Fillable Fileable	Form and instruction
Form 32	Old Empl-Priv Related Ins Section	Fillable Fileable	Form and instruction
Form 30	Managed Care Section	Fillable Fileable	Form and instruction
Form 29	Income Section	Fillable Fileable	Form and instruction
Form 28	Institutional Care Stay Section	Fillable Fileable	Form and instruction
Form 27	Health Insurance Section	Fillable Fileable	Form and instruction
Form 26	Hospital Stay Section	Fillable Fileable	Form and instruction
Form 24	Health Insurance Detail Section	Fillable Fileable	Form and instruction
Form 23	Home Health Section	Fillable Fileable	Form and instruction
Form 21	Global Section	Fillable Fileable	Form and instruction
Form 14	Employment Driver Section	Fillable Fileable	Form and instruction
Form 13	Employment Section	Fillable Fileable	Form and instruction
Form 12	Event Follow Up Section	Fillable Fileable	Form and instruction
Form 11	Event Enumeration Section	Fillable Fileable	Form and instruction
Form 10	Event Driver Section	Fillable Fileable	Form and instruction
Form 9	Dental Visit Section	Fillable Fileable	Form and instruction
Form 6	Contracting Module	Fillable Fileable	Form and instruction
Form 5	Closing Section	Fillable Fileable	Form and instruction
Form 3	Assets	Fillable Fileable	Form and instruction
Form 35	Outpatient Department Section	Fillable Fileable	Form and instruction
Form 31	Medical Visit Section	Fillable Fileable	Form and instruction
Form 18	Flat Fee Section	Fillable Fileable	Form and instruction
Form 22	Health Status Section	Fillable Fileable	Form and instruction
Form 8	Child Preventive Health Section	Fillable Fileable	Form and instruction
Form 25	Time Period Covered Detail Section	Fillable Fileable	Form and instruction

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