Information Collection

NAMCS and NHAMCS Patient Record Evaluation

IC 194864 under ICR 201002-0920-006 · OMB 0920-0222.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0222 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
NAMCS and NHAMCS Patient Record Evaluation	Form
Patient Record Evaluation NAMCS HNAMCS Attach 1.pdf	Form
NAMCS HNAMCS Attach 3 Invit letter.docx Invitational Letter	IC Document
NAMCS NHAMCS Attach 2 -intro.doc Introduction to Interview	IC Document
QDRL NAMCS & NHAMCS Evaluation-0930.doc Justification Letter	IC Document

IC Title:

NAMCS and NHAMCS Patient Record Evaluation

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Patient Record Evaluation	NAMCS HNAMCS Attach 1.pdf		No	No	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 20

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	20	0	0	0	0	0
Annual IC Time Burden (Hours)	20	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
Invitational Letter	NAMCS HNAMCS Attach 3 Invit letter.docx	10/04/2010
Introduction to Interview	NAMCS NHAMCS Attach 2 -intro.doc	10/04/2010
Justification Letter	QDRL NAMCS & NHAMCS Evaluation-0930.doc	10/04/2010

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