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Federal forms, ICRs, and supporting documents

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.

Documents and Forms
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Document Type
Form
Form
Form
Form
Form
Form
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

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

Document Type Form No. Form Name Instrument File URL 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

Health Public Health Monitoring

Health and Demographic Surveys Conducted in Probability Samples of the US Population  49 FR 37693

130 0
   
Individuals or Households
 
   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

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.