Information Collection

QDRL testing on NAMCS physician follow-up, NHIS Complementary and Alternative Medicine, and Spanish version of HIV behavioral surveillance

IC 196057 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⚠️ Notice: This information collection may be referencing outdated material.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:

2026-07-06 - Reinstatement without change of a previously approved collection
2025-05-01 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
NHBS - Spanish version for MSM QDRL testing on NAMCS physician follow-up, NHIS Complementary and Alternative Medicine, and Spanish version of HIV behavioral surveillance	Form
Physican Workflow EHR no Adoption Survey QDRL testing on NAMCS physician follow-up, NHIS Complementary and Alternative Medicine, and Spanish version of HIV behavioral surveillance	Form
Physican Workflow EHR some Adoption Survey QDRL testing on NAMCS physician follow-up, NHIS Complementary and Alternative Medicine, and Spanish version of HIV behavioral surveillance	Form
Child Component of CAMS QDRL testing on NAMCS physician follow-up, NHIS Complementary and Alternative Medicine, and Spanish version of HIV behavioral surveillance	Form
NHBS - Spanish screener QDRL testing on NAMCS physician follow-up, NHIS Complementary and Alternative Medicine, and Spanish version of HIV behavioral surveillance	Form
Physican Workflow EHR no Adoption Survey EMR Attach 1b.docx	Form
Physican Workflow EHR some Adoption Survey EMR Attach 1a.docx	Form
Child Component of CAMS NHIS CAM Attach 1.docx	Form
NHBS - Spanish version for MSM Spanish NHBS Attachment 1abc.docx	Form
NHBS - Spanish screener Spanish NHBS Attachment 3abc.docx	Form
QDRL EMR letter-0112 2011.doc Physican Workflow EHR Adoption Survey - 10 day letter	IC Document
EMR Attach 2a&b-0112 2011.docx Physician Workflow and EHR Survey - advance letters	IC Document
NHIS CAM 2012 10-day letter.doc NHIS Complementary and Alternative Medicine Supplement - 10 day letter	IC Document
NHIS CAM Attach 2.docx CAMS - advertisement/flyer	IC Document
Spanish NHBS QDRL OMB-10-day letter fnl.doc NHBS Spanish version - 10 day letter	IC Document
Spanish NHBS Attachment 2abc.docx NHBS - Spanish flyer	IC Document
QDRL-2011 OMB-10-day combo letter 011211.doc Letter for combined generic ICs	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

QDRL testing on NAMCS physician follow-up, NHIS Complementary and Alternative Medicine, and Spanish version of HIV behavioral surveillance

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	NHBS - Spanish version for MSM	Spanish NHBS Attachment 1abc.docx	Yes	Yes	Fillable Fileable
Form	none	NHBS - Spanish screener	Spanish NHBS Attachment 3abc.docx	Yes	Yes	Fillable Fileable
Form	none	Physican Workflow EHR no Adoption Survey	EMR Attach 1b.docx	Yes	Yes	Fillable Fileable
Form	none	Physican Workflow EHR some Adoption Survey	EMR Attach 1a.docx	Yes	Yes	Fillable Fileable
Form	none	Child Component of CAMS	NHIS CAM Attach 1.docx	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Health and Demographic Surveys Conducted in Probability Samples of the US Population

FR Citation: 49 FR 37693

Number of Respondents: 130

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	130	0	0	0	0	0
Annual IC Time Burden (Hours)	160	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
Physican Workflow EHR Adoption Survey - 10 day letter	QDRL EMR letter-0112 2011.doc	01/19/2011
Physician Workflow and EHR Survey - advance letters	EMR Attach 2a&b-0112 2011.docx	01/19/2011
NHIS Complementary and Alternative Medicine Supplement - 10 day letter	NHIS CAM 2012 10-day letter.doc	01/19/2011
CAMS - advertisement/flyer	NHIS CAM Attach 2.docx	01/19/2011
NHBS Spanish version - 10 day letter	Spanish NHBS QDRL OMB-10-day letter fnl.doc	01/19/2011
NHBS - Spanish flyer	Spanish NHBS Attachment 2abc.docx	01/19/2011
Letter for combined generic ICs	QDRL-2011 OMB-10-day combo letter 011211.doc	01/19/2011

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