Pretest for the 1997 Medical Expenditure Survey Insurance Component

Forms and Documents

Document Name	Status

No forms / supporting documents in this ICR. Check IC Document Collections.

IC Document Collections

IC ID	Document Title	Status
7694	Pretest for the 1997 Medical Expenditure Survey Insurance Component	Migrated

ICR Details

OMB Control No: 0935-0097	ICR Reference No: 199610-0935-001
Status: Historical Active	Previous ICR Reference No: 199506-0935-001
Agency/Subagency: HHS/AHRQ	Agency Tracking No:
Title: Pretest for the 1997 Medical Expenditure Survey Insurance Component
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 10/15/1996
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/06/1996
	Date Received in OIRA: 10/09/1996
Terms of Clearance: Approved for use through 2/97 under the following conditions: 1) to facilitate ongoing coordination between employer-based insur- ance surveys, AHCPR "swears in" BLS employees on the Census team for the pretest and briefs OMB on the involvment of BLS in the pretest and its evaluation; 2) AHCPR conducts a thorough evalua- tion of its HIPS/NEHIS integration and how it may overlap with existing data efforts such as the BLS Comp 2000. AHCPR must present a justification supporting its separate employer-based effort, including consideration of the burdens imposed by multi- ple surveys which collect similar information from an identical sample of private firms. OMB has asked BLS to conduct a similar analysis. OMB carefully will consider AHCPR's justification before agreeing to the full scale fielding of this instrument; and 3) the analysis also should contain a discussion regarding the long term sponsorship of this effort and the agency/private sector entities that may be involved in its implementation.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/1997	02/28/1997	12/31/1996
Responses	350	0	1
Time Burden (Hours)	263	0	263
Cost Burden (Dollars)	0	0	0

---

Abstract: This is a pretest of a survey of employers and health insurance providers. Sample cases come from providers of insurance to respondents from a pretest of a household survey. Cases also come from lists of businesses and governments. The pretest is required to codify operations for a proposed 1997 survey.

Emergency Justfication:

---

Authorizing Statute(s): None

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:

---

Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Pretest for the 1997 Medical Expenditure Survey Insurance Component

---

ICR Summary 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	350	1	0	349	0	0
Annual Time Burden (Hours)	263	263	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 10/09/1996

---