NAMCS-30 Patient Record form (Line 3)

National Ambulatory Medical Care Survey

OMB: 0920-0234

IC ID: 181890

Information Collection (IC) Details

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NAMCS-30 Patient Record form (Line 3)
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 3 NAMCS-30 Patient Record form (Line 3) NAMCS 10-12 OMB ATT J.pdf No No Paper Only

Health Public Health Monitoring

09-20-0167 Health Resources Utilization Statistics  49 FR 37693

738 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   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 22,140 0 0 0 0 22,140
Annual IC Time Burden (Hours) 3,321 0 0 0 0 3,321
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
NAMCS Instruction booklet NAMCS 09-12 Attachment H.pdf 05/11/2009
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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