| HHS Privacy Impact Assessment (PIA) Summary |
| AHRQ: AHRQ Medical Expenditure Panel Survey (MEPS) |
| Summary of PIA Required Questions |
| The following required questions represent the information necessary to complete the PIA Summary for transmission to the Office of Management and |
| Budget. Note: If a question or its response is not applicable, please answer “No” to that question. |
1
System:
AHRQ Medical Expenditure Panel Survey (MEPS)
2
Is this a new PIA?
No
3
| If this is an existing PIA, please provide a reason |
| for revision: |
PIA Validation
4
Date of this Submission:
May 24, 2006
5
OPDIV Name:
AHRQ
6
Unique Project Identifier (UPI) Number:
| 009-33-01-04-01-0011-00; (009-33-01-04-01-0011-00-110-218; |
| 009-33-01-04-01-0011-00-202-070) |
7
Privacy Act System of Records (SOR) Number:
09-35-0002
8
OMB Information Collection Approval Number:
N/A
9
Other Identifying Number(s):
N/A
10
System Name:
Medical Expenditure Panel Survey (MEPS)
11
| System Point of Contact (POC). The System POC |
| is the person to whom questions about the system |
| and the responses to this PIA may be addressed: |
Eric Colombel
12
Provide an overview of the system:
Data collection and dissemination
13
| Indicate if the system is new or an existing one |
| being modified: |
Existing
14
| Does/Will the system collect, maintain (store), |
| disseminate and/or pass through IIF within any |
| database(s), record(s), file(s) or website(s) hosted |
| by this system? |
Yes
15
Is the system subject to the Privacy Act?
No
16
| If the system shares or discloses IIF please specify |
| with whom and for what purpose(s): |
| The agency does not share the IIF. Only non-IIF information is |
| shared. |
17
| Describe in detail the information the agency will |
| collect, maintain, or disseminate and why and for |
| what purpose the agency will use the information: |
| The information collected is: the age, race, and sex of each |
| family member; Health conditions; Current Health Status; Visits to |
| health care providers (doctors, dentists, hospitals, etc.); Charges |
| and Payments for Health Care; Medications; Employment; Heal |
18
Describe the consent process:
| The information is gathered through a face-to-face interview |
| process with the selected participants. Prior to the interview |
| prosses it is explained to the participants what data is being |
| collected, why, and how the data is shared and protected. |
19
Does the system host a website?
Yes
20
| Does the website have any information or pages |
| directed at children under the age of thirteen? |
No
21
| Are there policies or guidelines in place with regard |
| to the retention and destruction of IIF? |
Yes
22
Are there technical controls present?
Yes
23
Describe the IIF security controls:
| The IIF information is secured on a protected network that only |
| accessible from specific terminals. This network has no access to |
| the Internet or any other network. |
24
Sr Official of Privacy Signature:
Tim Erny
25
Sr Official of Privacy Signoff Date:
May 25, 2006
| Note on IIF: Any question about IIF seeks to identify any, and all, personal information associated with the system. This includes any IIF, whether or not it |
| is subject to the Privacy Act, whether the individuals are employees, the public, research subjects, or business partners, and whether provided voluntarily |
| or collected by mandate. Later questions will try to understand the character of the data and its applicability to the requirements under the Privacy Act or |
| other legislation. Note: If no IIF is contained in the system, please answer the remaining required questions, then promote the PIA to the Sr. Privacy |
| Official who will authorize the PIA. Note: If this system contains IIF, all remaining questions on the PIA Form Tabs must be completed prior to signature |
| and promotion. |
