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

NCHS Questionnaire Design Research Laboratory

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
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

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:

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

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 %

	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

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.