2011 Pretest NAMCS Patient Record Form (line 10)

National Ambulatory Medical Care Survey

OMB: 0920-0234

IC ID: 196407

Information Collection (IC) Details

View Information Collection (IC)

2011 Pretest NAMCS Patient Record Form (line 10)
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none 2011 Pretest NAMCS Patient Record Att T Pretest PRF.doc No No Paper Only

Health Public Health Monitoring

Health Resources Utilization Statistics  49 FR 37693

100 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 100 0 100 0 0 0
Annual IC Time Burden (Hours) 23 0 23 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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