National Hospital Ambulatory Medical Care Survey

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
NHAMCS 83c Exp date issue 2009 121207.doc	Justification for No Material/Nonsubstantive Change	Uploaded 2007-12-17	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
43613	Ancillary Service Executive/Hospital Induction Pandemic and Emergency Response Preparedness Questions	Instruction	Modified
181869	Medical Record Clerk/ Pulling and re-filing OPD Patient Record	Instruction	Modified
181868	Medical Record Clerk/ Pulling and re-filing ED Patient Record	Instruction	Modified
181867	Physician/ Registered Nurse/Medical Record Clerk OPD Patient Record Form	Instruction	Modified
181866	Ancillary Service Executive/Ambulatory Unit Induction (OPD)	Instruction	Modified
181865	Physcian/Registered Nurse Medical Record Clerk ED Patient Record Form	Instruction	Modified
181864	Hospital Chief Medical Officer/Ancillary Service Executive/Hospital Induction/Ambulatory Unit Induction (ED)	Instruction	Modified
181863	Hospital Chief Medical Officer/Physician Assistant/Nurse Practitioner Hospital Induction(Ineligible)/Cervical Cancer Screening Supplement	Instruction	Modified

ICR Details

OMB Control No: 0920-0278	ICR Reference No: 200801-0920-004
Status: Historical Active	Previous ICR Reference No: 200709-0920-001
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: National Hospital Ambulatory Medical Care Survey
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/11/2008
	Date Received in OIRA: 01/04/2008
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2009	08/31/2009	08/31/2009
Responses	90,031	0	90,031
Time Burden (Hours)	7,312	0	7,312
Cost Burden (Dollars)	0	0	0

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Abstract: Data collected from hospital emergency and outpatient departments concerning patient visits are weighted to produce national estimates. This request for nonsubstantive change will permit NHAMCS to omit the OMB expiration date from 2009 survey forms to save considerable funds during a transition year.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 8

table that charts list of burden

IC Title	Form No.	Form Name
Medical Record Clerk/ Pulling and re-filing OPD Patient Record
Ancillary Service Executive/Hospital Induction Pandemic and Emergency Response Preparedness Questions
Hospital Chief Medical Officer/Physician Assistant/Nurse Practitioner Hospital Induction(Ineligible)/Cervical Cancer Screening Supplement
Hospital Chief Medical Officer/Ancillary Service Executive/Hospital Induction/Ambulatory Unit Induction (ED)
Physcian/Registered Nurse Medical Record Clerk ED Patient Record Form
Ancillary Service Executive/Ambulatory Unit Induction (OPD)
Physician/ Registered Nurse/Medical Record Clerk OPD Patient Record Form
Medical Record Clerk/ Pulling and re-filing ED Patient Record

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ICR Summary of Burden

table that charts list 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	90,031	90,031	0	0	0	0
Annual Time Burden (Hours)	7,312	7,312	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:

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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

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Common Form ICR:  No

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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: 01/03/2008

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