Federal Register / Vol. 77, No. 114 / Wednesday, June 13, 2012 / Notices 35399 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Agency for Healthcare Research and 

Quality Agency Information Collection 

Activities 

Proposed Collection; Comment 

Request 

AGENCY: Agency for Healthcare Research 

and Quality, HHS. 

ACTION: Notice. 

SUMMARY: This notice announces the 

intention of the Agency for Healthcare 

Research and Quality (AHRQ) to request 

that the Office of Management and 

Budget (OMB) approve the proposed 

information collection project: ‘‘Medical 

Expenditure Panel Survey (MEPS) 

Household Component and the MEPS 

Medical Provider Component’’ In 

accordance with the Paperwork 

Reduction Act, 44 U.S.C. 3501–3521, 

AHRQ invites the public to comment on 

this proposed information collection. 

DATES: Comments on this notice must be 

received by August 13, 2012. 

ADDRESSES: Written comments should 

be submitted to: Doris Lefkowitz, 

Reports Clearance Officer, AHRQ, by 

email at doris.lefkowitz@AHRQ.hhs.gov. 

Copies of the proposed collection 

plans, data collection instruments, and 

specific details on the estimated burden 

can be obtained from the AHRQ Reports 

Clearance Officer. 

FOR FURTHER INFORMATION CONTACT: 

Doris Lefkowitz, AHRQ Reports 

Clearance Officer, (301) 427–1477, or by 

email at doris.lefkowitz@AHRQ.hhs.gov. 

SUPPLEMENTARY INFORMATION: 

Proposed Project 

Medical Expenditure Panel Survey 

(MEPS) Household Component and the 

MEPS Medical Provider Component 

For over thirty years, results from the 

MEPS and its predecessor surveys (the 

1977 National Medical Care 

Expenditure Survey, the 1980 National 

Medical Care Utilization and 

Expenditure Survey and the 1987 

National Medical Expenditure Survey) 

have been used by OMB, DHHS, 

Congress and a wide number of health 

services researchers to analyze health 

care use, expenses and health policy. 

Major changes continue to take place 

in the health care delivery system. The 

MEPS is needed to provide information 

about the current state of the health care 

system as well as to track changes over 

time. The MEPS permits annual 

estimates of use of health care and 

expenditures and sources of payment 

for that health care. It also permits 

tracking individual change in 

employment, income, health insurance 

and health status over two years. The 

use of the National Health Interview 

Survey (NHIS) as a sampling frame 

expands the MEPS analytic capacity by 

providing another data point for 

comparisons over time. 

Households selected for participation 

in the MEPS Household Component 

(MEPS–HC) are interviewed five times 

in person. These rounds of interviewing 

are spaced about 5 months apart. The 

interview will take place with a family 

respondent who will report for him/ 

herself and for other family members. 

The MEPS–HC has the following goal: 

• To provide nationally 

representative estimates for the U.S. 

civilian noninstitutionalized population 

for health care use, expenditures, 

sources of payment and health 

insurance coverage. 

The MEPS Medical Provider 

Component (MEPS–MPC) will contact 

medical providers (hospitals, 

physicians, home health agencies and 

institutions) identified by household 

respondents in the MEPS–HC as sources 

of medical care for the time period 

covered by the interview, and all 

pharmacies providing prescription 

drugs to household members during the 

covered time period. The MEPS–MPC is 

not designed to yield national estimates. 

The sample is designed to target the 

types of individuals and providers for 

whom household reported expenditure 

data was expected to be insufficient. For 

example, households with one or more 

Medicaid enrollees are targeted for 

inclusion in the MEPSMPC because this 

group is expected to have limited 

information about payments for their 

medical care. 

The MEPS–MPC has the following 

goal: 

• To provide an imputation source to 

supplement/replace household reported 

expenditure and source of payment 

information. This data will supplement, 

replace and verify information provided 

by household respondents about the 

charges, payments, and sources of 

payment associated with specific health 

care encounters. 

This study is being conducted by 

AHRQ through its contractors, Westat 

and RTI International, pursuant to 

AHRQ’s statutory authority to conduct 

and support research on healthcare and 

on systems for the delivery of such care, 

including activities with respect to the 

cost and use of health care services and 

with respect to health statistics and 

surveys. 42 U.S.C. 299a(a)(3) and (8); 42 

U.S.C. 299b–2. 

Method of Collection 

To achieve the goals of the MEPS–HC 

the following data collections are 

implemented: 

1. Household Component Core 

Instrument. The core instrument 

collects data about persons in sample 

households. Topical areas asked in each 

round of interviewing include condition 

enumeration, health status, health care 

utilization including prescribed 

medicines, expense and payment, 

employment, and health insurance. 

Other topical areas that are asked only 

once a year include access to care, 

income, assets, satisfaction with health 

plans and providers, children’s health, 

and adult preventive care. While many 

of the questions are asked about the 

entire reporting unit (RU), which is 

typically a family, only one person 

normally provides this information. 

2. Adult Self Administered 

Questionnaire. A brief self-administered 

questionnaire (SAQ) will be used to 

collect self-reported (rather than 

through household proxy) information 

on health status, health opinions and 

satisfaction with health care for adults 

18 and older. The satisfaction with 

health care items are a subset of items 

from the Consumer Assessment of 

Healthcare Providers and Systems 

(CAHPS®). The health status items are 

from the Short Form 12 Version 2 (SF– 

12 version 2), which has been widely 

used as a measure of self-reported 

health status in the United States, the 

Kessler Index (K6) of non-specific 

psychological distress, and the Patient 

Health Questionnaire (PHQ–2). 

3. Diabetes Care SAQ. A brief self 

administered paper-and-pencil 

questionnaire on the quality of diabetes 

care is administered once a year (during 

rounds 3 and 5) to persons identified as 

having diabetes. Included are questions 

about the number of times the 

respondent reported having a 

hemoglobin A1c blood test, whether the 

respondent reported having his or her 

feet checked for sores or irritations, 

whether the respondent reported having 

an eye exam in which the pupils were 

dilated, the last time the respondent had 

his or her blood cholesterol checked and 

whether the diabetes has caused kidney 

or eye problems. Respondents are also 

asked if their diabetes is being treated 

with diet, oral medications or insulin. 

4. Permission forms for the MEPS– 

MPC Provider and Pharmacy Survey. As 

in previous panels of the MEPS, we will 

ask respondents for permission to obtain 

supplemental information from their 

medical providers (hospitals, 

physicians, home health agencies and 

institutions) and pharmacies. 


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To achieve the goal of the MEPS–MPC 

the following data collections are 

implemented: 

1. MPC Screening Call. An initial 

screening call is placed to determine the 

type of facility, whether the practice or 

facility is in scope for the MEPS–MPC, 

the appropriate MEPS–MPC respondent 

and some details about the organization 

and availability of medical records and 

billing at the practice/facility. All 

hospitals, physician offices, home 

health agencies, institutions and 

pharmacies are screened by telephone. 

A unique screening instrument is used 

for each of the seven provider types in 

the MEPS–MPC. 

2. Home Care Provider Questionnaire 

for Health Care Providers. This 

questionnaire is used to collect data 

from home health care agencies which 

provide medical care services to 

household respondents. Information 

collected includes type of personnel 

providing care, hours or visits provided 

per month, and the charges and 

payments for services received. 

3. Home Care Provider Questionnaire 

for Non-Health Care Providers. This 

questionnaire is used to collect 

information about services provided in 

the home by non-health care workers to 

household respondents because of a 

medical condition; for example, 

cleaning or yard work, transportation, 

shopping, or child care. 

4. Medical Event Questionnaire for 

Office-Based Providers. This 

questionnaire is for office-based 

physicians, including doctors of 

medicine (MDs) and osteopathy (DOs), 

as well as providers practicing under 

the direction or supervision of an MD or 

DO (e.g., physician assistants and nurse 

practitioners working in clinics). 

Providers of care in private offices as 

well as staff model HMOs are included. 

5. Medical Event Questionnaire for 

Separately Billing Doctors. This 

questionnaire collects information from 

physicians identified by hospitals 

(during the Hospital Event data 

collection) as providing care to sampled 

persons during the course of inpatient, 

outpatient department or emergency 

room care, but who bill separately from 

the hospital. 

6. Hospital Event Questionnaire. This 

questionnaire is used to collect 

information about hospital events, 

including inpatient stays, outpatient 

department, and emergency room visits. 

Hospital data are collected not only 

from the billing department, but from 

medical records and administrative 

records departments as well. Medical 

records departments are contacted to 

determine the names of all the doctors 

who treated the patient during a stay or 

visit. In many cases, the hospital 

administrative office also has to be 

contacted to determine whether the 

doctors identified by medical records 

billed separately from the hospital itself; 

the doctors that do bill separately from 

the hospital will be contacted as part of 

the Medical Event Questionnaire for 

Separately Billing Doctors. HMOs are 

included in this provider type. 

7. Institutions Event Questionnaire. 

This questionnaire is used to collect 

information about institution events, 

including nursing homes, rehabilitation 

facilities and skilled nursing facilities. 

Institution data are collected not only 

from the billing department, but from 

medical records and administrative 

records departments as well. Medical 

records departments are contacted to 

determine the names of all the doctors 

who treated the patient during a stay. In 

many cases, the institution 

administrative office also has to be 

contacted to determine whether the 

doctors identified by medical records 

billed separately from the institution 

itself. 

8. Pharmacy Data Collection 

Questionnaire. This questionnaire 

requests the national drug code (NDC) 

and when that is not available the 

prescription name, date prescription 

was filled, payments by source, 

prescription strength and form (when 

the NDC is not available), quantity, and 

person for whom the prescription was 

filled. When the NDC is available, we do 

not ask for prescription name, strength 

or form because that information is 

embedded in the NDC; this reduces 

burden on the respondent. Most 

pharmacies have the requested 

information available in electronic 

format and respond by providing a 

computer generated printout of the 

patient’s prescription information. If the 

computerized form is unavailable, the 

pharmacy can report their data to a 

telephone interviewer. Pharmacies are 

also able to provide a CD–ROM with the 

requested information if that is 

preferred. HMOs are included in this 

provider type. 

The MEPS is a multi-purpose survey. 

In addition to collecting data to yield 

annual estimates for a variety of 

measures related to health care use and 

expenditures, the MEPS also provides 

estimates of measures related to health 

status, consumer assessment of health 

care, health insurance coverage, 

demographic characteristics, 

employment and access to health care 

indicators. Estimates can be provided 

for individuals, families and population 

subgroups of interest. Data from the 

MEPS, both the HC and MPC 

components, are intended for a number 

of annual reports required to be 

produced by AHRQ, including the 

National Health Care Quality Report and 

the National Health Care Disparities 

Report. 

Estimated Annual Respondent Burden 

Exhibit 1 shows the estimated 

annualized burden hours for the 

respondents’ time to participate in the 

MEPS–HC and MEPS–MPC. The MEPS– 

HC Core Interview will be completed by 

12,500 ‘‘family level’’ respondents, also 

referred to as RU respondents. Since the 

MEPS–HC consists of 5 rounds of 

interviewing covering a full two years of 

data, the annual average number of 

responses per respondent is 2.5 

responses per year. The MEPS–HC core 

requires an average response time of 11⁄2

hours to administer. The Adult SAQ 

will be completed once a year by each 

person in the RU that is 18 years old 

and older, an estimated 22,000 persons. 

The Adult SAQ requires an average of 

7 minutes to complete. The Diabetes 

care SAQ will be completed once a year 

by each person in the RU identified as 

having diabetes, an estimated 1,700 

persons, and takes about 3 minutes to 

complete. The permission form for the 

MEPS–MPC Provider Survey will be 

completed once for each medical 

provider seen by any RU member. Each 

of the 12,500 RUs in the MEPS–HC will 

complete an average of 5.2 forms, which 

require about 3 minutes each to 

complete. The permission form for the 

MEPS–MPC Pharmacy Survey will be 

completed once for each pharmacy for 

any RU member who has obtained a 

prescription medication. Each RU will 

complete an average of 3.1 forms, which 

take about 3 minutes to complete. The 

total annual burden hours for the 

MEPS–HC are estimated to be 54,715 

hours. 

All 37,600 medical providers and 

pharmacies included in the MEPS–MPC 

will receive a screening call which will 

take 2 minutes on average. The MEPS– 

MPC uses 7 different questionnaires; 6 

for medical providers and 1 for 

pharmacies. Each questionnaire is 

relatively short and requires 3 to 5 

minutes to complete. The total annual 

burden hours for the MEPS–MPC are 

estimated to be 20,565 hours. The total 

annual burden hours for the MEPS–HC 

and MPC is estimated to be 75,280 

hours. 

Exhibit 2 shows the estimated annual 

cost burden associated with the 

respondents’ time to participate in this 

information. The annual cost burden for 

the MEPS–HC is estimated to be 

$1,189,505; the annual cost burden for 

the MEPS–MPC is estimated to be 

$309,798. The total annual cost burden 


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Federal Register / Vol. 77, No. 114 / Wednesday, June 13, 2012 / Notices 35401 

for the MEPS–HC and MPC is estimated 

to be $1,499,303. 

EXHIBIT 1—ESTIMATED ANNUALIZED BURDEN HOURS

Form name Number of 

respondents 

Number of 

responses per 

respondent 

Hours per 

response 

Total burden 

hours 

MEPS–HC 

MEPS–HC Core Interview ............................................................................... 12,500 2.5 1.5 46,875 

Adult SAQ ........................................................................................................ 22,000 1 7/60 2,567 

Diabetes care SAQ .......................................................................................... 1,700 1 3/60 85 

Permission form for the MEPS–MPC Provider Survey ................................... 12,500 5.2 3/60 3,250 

Permission form for the MEPS–MPC Pharmacy Survey ................................ 12.500 3.1 3/60 1,938 

Subtotal for the MEPS–HC ....................................................................... 61,200 na na 54,715 

MEPS–MPC 

MPC Screening Call* ....................................................................................... 37,600 1 2/60 1,253 

Home care for health care providers questionnaire ........................................ 465 6.5 5/60 252 

Home care for non-health care providers questionnaire ................................. 35 6.6 5/60 19 

Office-based providers questionnaire .............................................................. 12,000 5.8 5/60 5,800 

Separately billing doctors questionnaire .......................................................... 12,000 2 3/60 1,200 

Hospitals questionnaire ................................................................................... 5,000 6.5 5/60 2,708 

Institutions (non-hospital) questionnaire .......................................................... 100 1.5 5/60 13 

Pharmacies questionnaire ............................................................................... 8,000 23.3 3/60 9,320 

Subtotal for the MEPS–MPC .................................................................... 75,200 na na 20,565 

Grand Total ....................................................................................... 136,400 na na 75,280 

* There are 7 different screening forms; one for each event type. The burden estimates for the individual forms ranges from 1 to 3 minutes. 

The estimate of 2 minutes used here is an average across all 7 screening forms. 

EXHIBIT 2—ESTIMATED ANNUALIZED COST BURDEN

Form name Number of 

respondents 

Total burden 

hours 

Average hourly wage rate Total cost 

burden 

MEPS–HC 

MEPS–HC Core Interview ............................................................................... 12,500 46,875 $21.74* $1,019,06 

Adult SAQ ........................................................................................................ 22,000 2,567 21.74 55,807 

Diabetes care SAQ .......................................................................................... 1,700 85 21.74 1,848

Permission form for the MEPS–MPC Provider Survey ................................... 12,500 3,250 21.74 70,655 

Permission form for the MEPS–MPC Pharmacy Survey ................................ 12.500 1,938 21.74 V42,132 

Subtotal for the MEPS–HC ....................................................................... 61,200 54,715 na 1,189,505 

MEPS–MPC 

MPC Screening Call ........................................................................................ 37,600 1,253 15.59** 19,534 

Home care for health care providers questionnaire ........................................ 465 252 15.59 3,929 

Home care for non-health care providers questionnaire ................................. 35 19 15.59 296 

Office-based providers questionnaire .............................................................. 12,000 5,800 15.59 90,422 

Separately billing doctors questionnaire .......................................................... 12,000 1,200 15.59 18,708 

Hospitals questionnaire ................................................................................... 5,000 2,708 15.59 42,218 

Institutions (non-hospital) questionnaire .......................................................... 100 13 15.59 203 

Pharmacies questionnaire ............................................................................... 8,000 9,320 14.43*** 134,488 

Subtotal for the MEPS–MPC .................................................................... 75,200 20,560 na 309,798 

Grand Total ....................................................................................... 136,400 75,275 na 1,499,303 

* Based upon the mean of the average wages for All Occupations (00–0000). 

** Based upon the mean of the average wages for Medical Secretaries (43–6013). 

*** Based upon the mean of the average wages for Pharmacy Technicians (29–2052). 

Occupational Employment Statistics, May 2011 National Occupational Employment and Wage Estimates United States, U.S. Department of 

Labor, Bureau of Labor Statistics. http://www.bls.gov/oes/current/oes_nat.htm#b29-0000. 


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35402 Federal Register / Vol. 77, No. 114 / Wednesday, June 13, 2012 / Notices 

Estimated Annual Costs to the Federal 

Government 

Exhibit 3 shows the total and 

annualized cost of this information 

collection. The cost associated with the 

design and data collection of the MEPS– 

HC and MEPS–MPC is estimated to be 

$51,401,596 in each of the three years 

covered by this information collection 

request. 

EXHIBIT 3—ESTIMATED TOTAL AND ANNUALIZED COST

Cost component Total cost Annualized cost 

Sampling Activities ....................................................................................................................................... $3,002,731 $1,000,910 

Interviewer Recruitment and Training ......................................................................................................... 9,190,168 3,063,389 

Data Collection Activities ............................................................................................................................. 93,611,428 31,203,809 

Data Processing .......................................................................................................................................... 23,087,605 7,695,868 

Production of Public Use Data Files ........................................................................................................... 21,079,118 7,026,373 

Project Management .................................................................................................................................... 4,233,739 1,411,246 

Total ...................................................................................................................................................... 154,204,789 51,401,596 

Request for Comments 

In accordance with the Paperwork 

Reduction Act, comments on AHRQ’s 

information collection are requested 

with regard to any of the following: (a) 

Whether the proposed collection of 

information is necessary for the proper 

performance of AHRQ healthcare 

research and healthcare information 

dissemination functions, including 

whether the information will have 

practical utility; (b) the accuracy of 

AHRQ’s estimate of burden (including 

hours and costs) of the proposed 

collection(s) of information; (c) ways to 

enhance the quality, utility, and clarity 

of the information to be collected; and 

(d) ways to minimize the burden of the 

collection of information upon the 

respondents, including the use of 

automated collection techniques or 

other forms of information technology. 

Comments submitted in response to 

this notice will be summarized and 

included in the Agency’s subsequent 

request for OMB approval of the 

proposed information collection. All 

comments will become a matter of 

public record. 

Dated: June 1, 2012. 

Carolyn M. Clancy, 

Director. 

[FR Doc. 2012–14204 Filed 6–12–12; 8:45 am] 

BILLING CODE 4160–90–M 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Disease Control and 

Prevention 

[60-Day-12–12NF] 

Proposed Data Collections Submitted 

for Public Comment and 

Recommendations 

In compliance with the requirement 

of Section 3506(c)(2)(A) of the 

Paperwork Reduction Act of 1995 for 

opportunity for public comment on 

proposed data collection projects, the 

Centers for Disease Control and 

Prevention (CDC) will publish periodic 

summaries of proposed projects. To 

request more information on the 

proposed projects or to obtain a copy of 

the data collection plans and 

instruments, call 404–639–7570 and 

send comments to Kimberly S. Lane, 

CDC 1600 Clifton Road, MS–D74, 

Atlanta, GA 30333 or send an email to 

omb@cdc.gov. 

Comments are invited on (a) Whether 

the proposed collection of information 

is necessary for the proper performance 

of the functions of the agency, including 

whether the information shall have 

practical utility; (b) the accuracy of the 

agency’s estimate of the burden of the 

proposed collection of information; (c) 

ways to enhance the quality, utility, and 

clarity of the information to be 

collected; and (d) ways to minimize the 

burden of the collection of information 

on respondents, including through the 

use of automated collection techniques 

or other forms of information 

technology. Written comments should 

be received within 60 days of this 

notice. 

Proposed Project 

School Environment Study: 

Evaluating the Effects of CTG-supported 

School-based Nutrition and Physical 

Activity Policies on Students’ Diet, 

Physical Activity, and Weight Status— 

New—National Center for Chronic 

Disease Prevention and Health 

Promotion (NCCDPHP), Centers for 

Disease Control and Prevention (CDC). 

Background and Brief Description 

The Prevention and Public Health 

Fund (PPHF) of the Patient Protection 

and Affordable Care Act of 2010 (ACA) 

provides an important opportunity for 

states, counties, territories, and tribes to 

advance public health across the 

lifespan and to reduce health 

disparities. The PPHF authorizes 

Community Transformation Grants 

(CTG) for the implementation, 

evaluation, and dissemination of 

evidence-based community preventive 

health activities. The CTG program 

emphasizes five strategic directions: (1) 

Tobacco-free living; (2) active lifestyles 

and healthy eating; (3) high impact, 

evidence-based clinical and other 

preventive services; (4) social and 

emotional well-being; and (5) healthy 

and safe physical environments. 

The CTG program is administered by 

the Centers for Disease Control and 

Prevention (CDC), National Center for 

Chronic Disease Prevention and Health 

Promotion (NCCDPHP). As required by 

Section 4201 of the ACA, CDC is 

responsible for conducting a 

comprehensive evaluation of the CTG 

program which includes assessment 

over time of measures relating to each 

of the five strategic directions. CDC is 

requesting OMB approval to collect 

information needed for these 

assessments. This information 

collection will enable a multi-method 

evaluation of the school nutrition and 

physical activity environments and on 

related health indictors among students. 

The School Environment Study involves 

a quasi-experimental design that will 

assess nutrition-, physical activity-, and 

obesity-related outcomes and impacts, 

and compare differential changes in 

these outcomes and impacts between 

students sampled in middle schools 

supported by the CTG program and 

students sampled in middle schools not 

supported by the CTG program. 

Four CTG program awardees 

(Broward County, Florida; Travis 

County, Texas; eight counties in 

Massachusetts (excludes the city of 

Boston and surrounding area); and Los 

Angeles County, California) were 

selected to participate in the School 


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