Lab Values Pretest Induction form

NCHS National Ambulatory Medical Care Survey

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0234 can be found here:

Documents and Forms

Document Name Document Type
Form unnumbered Lab Values Pretest Induction form Form
unnumbered Lab Values Pretest Induction form NAMCS 09-12 OMB ATT K.pdf Form
NAMCS 09-12 OMB ATT R.pdf Lab Values Pretest Instructions IC Document

Information Collection (IC) Details

IC Title:	Lab Values Pretest Induction form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	unnumbered	Lab Values Pretest Induction form	NAMCS 09-12 OMB ATT K.pdf		No	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09-20-0167 Health Resources Utilization Statistics	FR Citation: 49 FR 37693

Number of Respondents: 23	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	23	23
Annual IC Time Burden (Hours)	11	11
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Lab Values Pretest Instructions	NAMCS 09-12 OMB ATT R.pdf	05/11/2009

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