National Ambulatory Medical Care Survey

Forms and Documents

Document Name	Status
Form 1 NAMCS-1 Physician Induction Interview (Line 1) Form and Instruction	Modified
Form unnumbered Lab Values Pretest Induction form Form	Removed
Form unnumbered Electronic Medical Record/Electronic Health Record Mail Survey Form Form	Removed
Form 6 NAMCS EMR/EHR Mail Survey (Line 6) Form and Instruction	Modified
Form 5 NAMCS-CCS Cervical Cancer Screening Supplement (Line 5) Form	Modified
Form 4 Pulling and re-filing Patient Record form (Line 4) Form	Modified
Form 3 NAMCS-30 Patient Record form (Line 3) Form and Instruction	Modified
Form 2 NAMCS-201 Community Health Center Induction Interview (Line 2) Form and Instruction	Modified
Final NAMCS 10-12 OMB SS-B.doc Supporting Statement B	2010-01-29
NAMCS 10-12 OMB ATT V.pdf Supplementary Document	2010-01-29
NAMCS 10-12 OMB ATT S.pdf Supplementary Document	2010-01-29
NAMCS 10-12 OMB ATT P.pdf Supplementary Document	2010-01-29
NAMCS 10-12 OMB ATT M.pdf Supplementary Document	2010-01-29
NAMCS 10-12 OMB ATT L.pdf Supplementary Document	2010-01-29
NAMCS 10-12 OMB ATT H.pdf Supplementary Document	2010-01-29
NAMCS 10-12 OMB ATT E.pdf Supplementary Document	2010-01-29
NAMCS 10-12 OMB ATT D.pdf Supplementary Document	2010-01-29
NAMCS 10-12 OMB ATT C.pdf Supplementary Document	2010-01-29
NAMCS 10-12 OMB ATT B.pdf Supplementary Document	2010-01-29
NAMCS 10-12 OMB ATT A.pdf Supplementary Document	2010-01-29
NAMCS 09-12 OMB ATT R.pdf Supplementary Document	2009-05-11
NAMCS 09-12 OMB ATT S.pdf Supplementary Document	2009-05-11
NAMCS 09-12 Attachment H.pdf Supplementary Document	2009-05-11
NAMCS 09-12 Attachment G.pdf Supplementary Document	2009-06-04
Final NAMCS 10-12 OMB SS-A.doc Supporting Statement A	2010-01-29

IC Document Collections

IC ID	Document Title	Status
43612	NAMCS-1 Physician Induction Interview (Line 1) Form and Instruction	Modified
189599	Lab Values Pretest Induction form Form	Removed
189598	Electronic Medical Record/Electronic Health Record Mail Survey Form Form	Removed
189597	NAMCS EMR/EHR Mail Survey (Line 6) Form and Instruction	Modified
181892	NAMCS-CCS Cervical Cancer Screening Supplement (Line 5) Form	Modified
181891	Pulling and re-filing Patient Record form (Line 4) Form	Modified
181890	NAMCS-30 Patient Record form (Line 3) Form and Instruction	Modified
181889	NAMCS-201 Community Health Center Induction Interview (Line 2) Form and Instruction	Modified

ICR Details

OMB Control No: 0920-0234	ICR Reference No: 201002-0920-004
Status: Historical Active	Previous ICR Reference No: 200906-0920-008
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: National Ambulatory Medical Care Survey
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/26/2010
	Date Received in OIRA: 02/04/2010
Terms of Clearance: When changes to the electronic medical records portion of this study are beginning to be considered, they should be shared with OMB to ensure coordination among the various Health IT initiatives (i.e., prior to submission of a change package to ROCIS). Prior terms continue:NCHS and OMB note that, should sufficient funding become available, it would be useful to add a quality assurance component that includes re-abstraction of medical records in the field. OMB also requests that NCHS explore more systematically the implications of the under-representation of larger, higher volume practices on the reported results (e.g., trends in care), and within six months, discuss your findings with our study design experts whether weighting might be in order.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2013	36 Months From Approved	07/31/2012
Responses	51,469	0	47,271
Time Burden (Hours)	7,372	0	5,932
Cost Burden (Dollars)	0	0	0

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Abstract: Data collected from office-based physicians, and community health center providers, concerning patient visits are aggregated to national statistics. This request will permit NAMCS to continue data collection on electronic medical record (EMR) with a five-fold increase in sample size starting in 2010. Increasing the sample size for the EMR mail survey allows the rate of EMR use to be estimated at the state level. This ICR is being submitted under Section 1512 of the American Recoveryand and Reinvestment Act of 2009, Public Law 111-5.

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Authorizing Statute(s): US Code: 42 USC 242K Name of Law: Public Health Service Act
   PL: Pub.L. 111 - 5 1512 Name of Law: American Recovery and Reinvestment Act of 2009
  

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
60-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 5660	01/30/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 4824	01/29/2010
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 6

IC Title	Form No.	Form Name
NAMCS-1 Physician Induction Interview (Line 1)	1	NAMCS-1 Physician Induction Interview (Line 1)
NAMCS-201 Community Health Center Induction Interview (Line 2)	2	NAMCS-201 Community Health Center Induction Interview (Line 2)
Pulling and re-filing Patient Record form (Line 4)	4	Pulling and re-filing Patient Record form (Line 4)
NAMCS-30 Patient Record form (Line 3)	3	NAMCS-30 Patient Record form (Line 3)
NAMCS-CCS Cervical Cancer Screening Supplement (Line 5)	5	NAMCS-CCS Cervical Cancer Screening Supplement (Line 5)
NAMCS EMR/EHR Mail Survey (Line 6)	6	NAMCS EMR/EHR Mail Survey (Line 6)
Electronic Medical Record/Electronic Health Record Mail Survey Form	unnumbered	EMR/EHR Mail Survey form
Lab Values Pretest Induction form	unnumbered	Lab Values Pretest Induction form

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ICR Summary 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	51,469	47,271	0	4,198	0	0
Annual Time Burden (Hours)	7,372	5,932	0	1,440	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The estimated annualized burden hours are higher in the current OMB request due to the expansion of the sample to provide state estimates of electronic medical record use.

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Annual Cost to Federal Government: $5,224,608

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)? Yes

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: 02/04/2010

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