Information Collection Request

National Ambulatory Medical Care Survey

ICR 201002-0920-004 · OMB 0920-0234 · Historical Active

Forms and Documents

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

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
43612 NAMCS-1 Physician Induction Interview (Line 1) Form and Instruction ModifiedNAMCS-1 Physician Induction Interview (Line 1)
189599 Lab Values Pretest Induction form Form RemovedLab Values Pretest Induction form
189598 Electronic Medical Record/Electronic Health Record Mail Survey Form Form RemovedEMR/EHR Mail Survey form
189597 NAMCS EMR/EHR Mail Survey (Line 6) Form and Instruction ModifiedNAMCS EMR/EHR Mail Survey (Line 6)
181892 NAMCS-CCS Cervical Cancer Screening Supplement (Line 5) Form ModifiedNAMCS-CCS Cervical Cancer Screening Supplement (Line 5)
181891 Pulling and re-filing Patient Record form (Line 4) Form ModifiedPulling and re-filing Patient Record form (Line 4)
181890 NAMCS-30 Patient Record form (Line 3) Form and Instruction ModifiedNAMCS-30 Patient Record form (Line 3)
181889 NAMCS-201 Community Health Center Induction Interview (Line 2) Form and Instruction ModifiedNAMCS-201 Community Health Center Induction Interview (Line 2)

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
02/28/2013 36 Months From Approved 07/31/2012
51,469 0 47,271
7,372 0 5,932
0 0 0





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

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 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


Reginfo record details
  No