2008 and 2009 Medical Expenditure Panel Survey - Insurance Componenet (MEPS-IC)

Forms and Documents

Document Name	Status
Form Form #3 2008 and 2009 Medical Expenditure Panel Survey - Insurance Component Plan Questionnaire Form and Instruction	New
Form Form #2 2008 and 2009 Medical Expenditure Panel Survey - Insurance Component Establishment Questionnaire Form and Instruction	New
Form Form #1 2008 and 2009 Medical Expenditure Panel Survey - Insurance Component Prescreener Questionnaire Form	New
2nd OMB response.doc Supplementary Document	2008-01-22
IC omb response.doc Supplementary Document	2008-01-22
Supporting Statement Part B.doc Supporting Statement B	2007-10-03
ATTACHMENT S NOA 2-3-2005.pdf Supplementary Document	2007-10-03
ATTACHMENTS list.doc Supplementary Document	2007-10-03
ATTACHMENT O Definitions.pdf Supplementary Document	2007-10-03
ATTACHMENT N thank you letter.doc Supplementary Document	2007-10-03
ATTACHMENT M fax followup govt.doc Supplementary Document	2007-10-03
ATTACHMENT L fax followup private.doc Supplementary Document	2007-10-03
ATTACHMENT K Followup Letter - Public Sector.doc Supplementary Document	2007-10-03
ATTACHMENT J Followup Letter - Private Sector.doc Supplementary Document	2007-10-03
ATTACHMENT I Cover Letter - Public Sector.doc Supplementary Document	2007-10-03
ATTACHMENT H Cover Letter - Private Sector.doc Supplementary Document	2007-10-03
ATTACHMENT G Stratum Sample.doc Supplementary Document	2007-10-03
ATTACHMENT F Sample Allocation Response.doc Supplementary Document	2007-10-03
ATTACHMENT E Confidentiality.doc Supplementary Document	2007-10-03
ATTACHMENT D Public Comments on Federal Register Notice.doc Supplementary Document	2007-10-03
ATTACHMENT C Federal Register Notice.doc Supplementary Document	2007-10-03
ATTACHMENT B AHRQ Legislation.pdf Supplementary Document	2007-10-03
ATTACHMENT A Article.doc Supplementary Document	2007-10-03
Supporting Statement Part A.doc Supporting Statement A	2007-10-03

IC Document Collections

IC ID	Document Title	Status
7714	2004 - 2006 Medical Expenditure Panel Survey - Insurance Componenet (MEPS-IC)	Removed
182461	2008 and 2009 Medical Expenditure Panel Survey - Insurance Component Plan Questionnaire Form and Instruction	New
182460	2008 and 2009 Medical Expenditure Panel Survey - Insurance Component Establishment Questionnaire Form and Instruction	New
182459	2008 and 2009 Medical Expenditure Panel Survey - Insurance Component Prescreener Questionnaire Form	New

ICR Details

OMB Control No: 0935-0110	ICR Reference No: 200710-0935-001
Status: Historical Active	Previous ICR Reference No: 200410-0935-002
Agency/Subagency: HHS/AHRQ	Agency Tracking No:
Title: 2008 and 2009 Medical Expenditure Panel Survey - Insurance Componenet (MEPS-IC)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/24/2008
	Date Received in OIRA: 10/25/2007
Terms of Clearance: Approved consistent with memos of 1-10-08 and 1-22-08.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2010	05/31/2010	04/30/2008
Responses	93,047	0	36,264
Time Burden (Hours)	19,032	0	20,922
Cost Burden (Dollars)	0	0	0

---

Abstract: Data is used by the Agency, other Federal, State and local agencies and the private sector to monitor and perform research on the topic of employer sponsor health insurance. Data from this survey supports calculation of Gross domestic product by the Bureau of Economic Analysis. Respondents are all public and private sector employers in the United States.

---

Authorizing Statute(s): US Code: 42 USC 299b-2 Name of Law: Health Care Quality Act of 1999
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 35487	06/28/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 52131	09/12/2007
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
2008 and 2009 Medical Expenditure Panel Survey - Insurance Component Prescreener Questionnaire	Form #1	Prescreener CATI Questionnaire
2004 - 2006 Medical Expenditure Panel Survey - Insurance Componenet (MEPS-IC)
2008 and 2009 Medical Expenditure Panel Survey - Insurance Component Establishment Questionnaire	Form #2	Establishment Questionnaire
2008 and 2009 Medical Expenditure Panel Survey - Insurance Component Plan Questionnaire	Form #3	Plan Questionnaire

---

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	93,047	36,264	0	56,783	0	0
Annual Time Burden (Hours)	19,032	20,922	0	-1,890	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Total burden hours declined due to program changes - both a reduction in sample size for the ongoing list sample, due to budget constraints, and the elimination of the linked sample.

---

Annual Cost to Federal Government: $10,300,000

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: 10/25/2007

---