Information Collection

Testing of: NHAMCS, NAMCS, 2010 "Itsinourhands" web site, 2010 CFU, 2010 ACS, and 2010 Mailout Materials

IC 186835 under ICR 200704-0607-002 · OMB 0607-0725.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0607-0725 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
NHAMCS2enc2.doc	Other-NHMACS Draft ASC Respondent De
NAMCS2enc1.doc	Other-Lipoprotien Cholesterol Values
NAMCS2enc2.doc	Other-Debriefing Questionnaire
NAMCS2enc3.doc	Other-Letter of Explanation
itsinourhands2010website user researchenc.doc	Other-User Interview Discussion Outl
2010CFU-CPEXenc2.doc	Other-Experimental Questions for Und
acs2010materialsenc1.pdf	Other-Mailing 1
acs2010materialsenc2.pdf	Other-Mailing 2
acs2010materialsenc3.pdf	Other-Mailing 3
acs2010materialsenc4.pdf	Other-Mailing 4
acs2010materialsenc5.pdf	Other-Mailing 5
acs2010materialsenc6.pdf	Other-Mailing 6
acs2010materialsenc7.pdf	Other-Mailing 7
acs2010materialsenc8.pdf	Other-Mailing 8
Census 2010 Mailout Materialsenc1.pdf	Other-envelope
Census 2010 Mailout Materialsenc2.pdf	Other-envelope
Census 2010 Mailout Materialsenc3.pdf	Other-letter
Census 2010 Mailout Materialsenc4.pdf	Other-letter
Census 2010 Mailout Materialsenc5.pdf	Other-envelope
Census 2010 Mailout Materialsenc6.pdf	Other-envelope
Census 2010 Mailout Materialsenc7.pdf	Other-postcard
Census 2010 Mailout Materialsenc8.pdf	Other-postcard
Census 2010 Mailout Materialsenc9.pdf	Other-postcard
Census 2010 Mailout Materialsenc10.pdf	Other-postcard
Census 2010 Mailout Materialsenc11.pdf	Other-letter
Census 2010 Mailout Materialsenc12.pdf	Other-letter
Census 2010 Mailout Materialsenc13.pdf	Other-letter
Census 2010 Mailout Materialsenc14.pdf	Other-letter
Census 2010 Mailout Materialsenc16.pdf	Other-envelope
NHAMCS-101 National Hospital AmbulatoryMedical Care Survey -- 2009 nhamcs101_071508.pdf	Form
NHAMCS-101(C) National Hospital Ambulatory Medical Care Survey -- 2009 nhamcs101c_07012008.pdf	Form
NMACS-101(U) Ambulatory Unit Record, National Hospital Ambulatory Med nhamcs101u_07012008.pdf	Form
NMACS-100(ASC) National Hospital Ambulatory Medical Care Survey -- 2009 nhamcs100asc_071508.pdf	Form
DD-1302 (CFU) Coverage Followup Questionnaire 2010CFU-CPEXenc1.pdf	Form
DY-1(X) Census 2010 Census 2010 Mailout Materialsenc15.pdf	Form
NHAMCS2rev.wpd NHMACS Testing Plan	IC Document
NAMCS2.wpd NAMCS Testing Plan	IC Document
itsinourhands2010website user researchrev2.doc Itsinourhands 2010 User Website Testing Plan	IC Document
2010CFU-CPEX.wpd 2010 CFU Testing Plan	IC Document
acs2010materials.doc ACS 2010 Mailout Materials Testing Plan	IC Document
Census 2010 Mailout Materials.wpd Census 2010 Mailout Materials Testing Plan	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Testing of: NHAMCS, NAMCS, 2010 "Itsinourhands" web site, 2010 CFU, 2010 ACS, and 2010 Mailout Materials

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Other-envelope			Census 2010 Mailout Materialsenc5.pdf	No	Paper Only
Other-envelope			Census 2010 Mailout Materialsenc6.pdf	No	Paper Only
Form	NHAMCS-101	National Hospital AmbulatoryMedical Care Survey -- 2009 Panel	nhamcs101_071508.pdf	No	Paper Only
Form	NHAMCS-101(C)	National Hospital Ambulatory Medical Care Survey -- 2009 Panel Control Card	nhamcs101c_07012008.pdf	No	Paper Only
Form	NMACS-101(U)	Ambulatory Unit Record, National Hospital Ambulatory Medical Care Survey -- 2009 Panel	nhamcs101u_07012008.pdf	No	Paper Only
Form	NMACS-100(ASC)	National Hospital Ambulatory Medical Care Survey -- 2009 Ambulatory Surgery Center Patient Record Folio	nhamcs100asc_071508.pdf	No	Paper Only
Other-NHMACS Draft ASC Respondent Debriefing			NHAMCS2enc2.doc	No	Paper Only
Other-Lipoprotien Cholesterol Values Worksheet			NAMCS2enc1.doc	No	Paper Only
Other-Debriefing Questionnaire			NAMCS2enc2.doc	No	Paper Only
Other-Letter of Explanation			NAMCS2enc3.doc	No	Paper Only
Other-User Interview Discussion Outline			itsinourhands2010website user researchenc.doc	No	Paper Only
Form	DD-1302 (CFU)	Coverage Followup Questionnaire	2010CFU-CPEXenc1.pdf	No	Paper Only
Other-Experimental Questions for Undercount Situation			2010CFU-CPEXenc2.doc	No	Paper Only
Other-Mailing 1			acs2010materialsenc1.pdf	No	Paper Only
Other-Mailing 2			acs2010materialsenc2.pdf	No	Paper Only
Other-Mailing 3			acs2010materialsenc3.pdf	No	Paper Only
Other-Mailing 4			acs2010materialsenc4.pdf	No	Paper Only
Other-Mailing 5			acs2010materialsenc5.pdf	No	Paper Only
Other-Mailing 6			acs2010materialsenc6.pdf	No	Paper Only
Other-Mailing 7			acs2010materialsenc7.pdf	No	Paper Only
Other-Mailing 8			acs2010materialsenc8.pdf	No	Paper Only
Other-envelope			Census 2010 Mailout Materialsenc1.pdf	No	Paper Only
Other-envelope			Census 2010 Mailout Materialsenc2.pdf	No	Paper Only
Other-letter			Census 2010 Mailout Materialsenc3.pdf	No	Paper Only
Other-letter			Census 2010 Mailout Materialsenc4.pdf	No	Paper Only
Other-postcard			Census 2010 Mailout Materialsenc8.pdf	No	Paper Only
Other-postcard			Census 2010 Mailout Materialsenc9.pdf	No	Paper Only
Other-postcard			Census 2010 Mailout Materialsenc10.pdf	No	Paper Only
Other-letter			Census 2010 Mailout Materialsenc11.pdf	No	Paper Only
Other-postcard			Census 2010 Mailout Materialsenc7.pdf	No	Paper Only
Other-letter			Census 2010 Mailout Materialsenc12.pdf	No	Paper Only
Other-letter			Census 2010 Mailout Materialsenc13.pdf	No	Paper Only
Other-letter			Census 2010 Mailout Materialsenc14.pdf	No	Paper Only
Form	DY-1(X)	Census 2010	Census 2010 Mailout Materialsenc15.pdf	No	Paper Only
Other-envelope			Census 2010 Mailout Materialsenc16.pdf	No	Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 130

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	130	0	0	0	0	0
Annual IC Time Burden (Hours)	150	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
NHMACS Testing Plan	NHAMCS2rev.wpd	10/09/2008
NAMCS Testing Plan	NAMCS2.wpd	10/07/2008
Itsinourhands 2010 User Website Testing Plan	itsinourhands2010website user researchrev2.doc	10/07/2008
2010 CFU Testing Plan	2010CFU-CPEX.wpd	10/07/2008
ACS 2010 Mailout Materials Testing Plan	acs2010materials.doc	10/09/2008
Census 2010 Mailout Materials Testing Plan	Census 2010 Mailout Materials.wpd	10/09/2008

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.