National Hospital Ambulatory Medical Care Survey

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Pretests	Form	Modified	Available
Form unnumbered ASC Patient Record Form	Form	Modified	Available
Form unnumbered Cervical Cancer Screening Supplement	Form	Modified	Available
Revised NHAMCS 2012-2014 Supporting Stat B OMB FINAL 12022011.docx	Supporting Statement B	Uploaded 2011-12-02	Available
Attachment Q - Colonoscopy Supplement Pilot Questions.docx	Supplementary Document	Uploaded 2011-10-20	Repair queued
Attachment H - Endorsing Letters.doc	Supplementary Document	Uploaded 2011-10-20	Available
Attachment G - Introductory Letters.doc	Supplementary Document	Uploaded 2011-10-20	Available
Attachment F - CDC #2010-03 IRB Approval for Continuation of Protocol.docx	Supplementary Document	Uploaded 2011-10-20	Available
Attachment E - List of Consultants.doc	Supplementary Document	Uploaded 2011-10-20	Available
Attachment D - Public Comment on 60 Day Notice.docx	Supplementary Document	Uploaded 2011-10-20	Available
Attachment B - List of Publications.docx	Supplementary Document	Uploaded 2011-10-20	Available
NHAMCS2010 Attachment S - NHAMCS-126.pdf	Supplementary Document	Uploaded 2009-06-08	Available
Revised NHAMCS 2012-2014 Supporting Stat A OMB FINAL 12022011.docx	Supporting Statement A	Uploaded 2011-12-02	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
43613	Ambulatory Unit Induction	Instruction	Modified
199913	Hospital Induction (new sample)	Instruction	New
198054	Pretests	Form	Modified
189813	Freestanding ASC Induction Form	Instruction	Modified
181868	Pulling and re-filing Patient Records	Instruction	Modified
181867	OPD Patient Record Form	Instruction	Modified
181866	ASC Patient Record Form	Form	Modified
181865	ED Patient Record Form	Instruction	Modified
181864	Hospital Induction Form	Instruction	Modified
181863	Cervical Cancer Screening Supplement	Form	Modified

ICR Details

OMB Control No: 0920-0278	ICR Reference No: 201110-0920-011
Status: Historical Active	Previous ICR Reference No: 201106-0920-008
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: National Hospital Ambulatory Medical Care Survey
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/02/2011
	Date Received in OIRA: 10/26/2011
Terms of Clearance: The addition of new modules will be considered an ICR revision.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2014	36 Months From Approved	08/31/2012
Responses	111,395	0	128,161
Time Burden (Hours)	9,999	0	12,194
Cost Burden (Dollars)	0	0	0

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Abstract: This request is for the revision of an approved data collection (OMB No. 0920-0278), the National Hospital Ambulatory Medical Care Survey (NHAMCS), to continue the survey activities for NHAMCS for 3 years and slightly modify survey activities. NHAMCS is a national survey of patient visits to emergency departments, outpatient departments, and ambulatory surgery locations of general and short-stay hospitals, as well as freestanding ambulatory surgery centers. We propose to revise NHAMCS for the purpose of converting data collection instruments from paper to computer-based instruments, adding 167 hospitals to the NHAMCS sample to make state-based estimates on emergency department characteristics, expanding the data collection to include a lookback module, conducting a colonoscopy supplement pretest, and making slight modifications to survey questions.

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Authorizing Statute(s): US Code: 42 USC 306 Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 6163	06/29/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 66070	10/25/2011
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 10

table that charts list of burden

IC Title	Form No.	Form Name
Cervical Cancer Screening Supplement	unnumbered	Att. T. Cervical Cancer Screening Supplement
Pulling and re-filing Patient Records
Freestanding ASC Induction Form
Pretests	none, none, none, none, none, none, none, none, none	Pulling & Refiling Records Pretest ,   Hospital Induction Pretest ,   Ambulatory Unit Induction pretest ,   Freestanding Ambulatory Surgery Center Induction ,   Asthma Management Supplement Pretest ,   Outpatient Dept Patient Record Pretest ,   Ambulatory Surgery Center Pretest ,   Emergency Dept Patient Pretest ,   Lookback Module Pretest
Hospital Induction (new sample)
OPD Patient Record Form
Ambulatory Unit Induction
Hospital Induction Form
ED Patient Record Form
ASC Patient Record Form	unnumbered	Att. O. ASC Patient Record Form

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	111,395	128,161	0	-16,766	0	0
Annual Time Burden (Hours)	9,999	12,194	0	-2,195	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Using Information Technology

Short Statement: Improved information technology will significantly reduce the burden for NHAMCS respondents when answering induction interview questions. Currently, completing the form requires a Census field representative (FR) to follow the flow of the form from front to back, navigating numerous skip patterns, adding information from complicated lists, and administering flash cards to the respondent. This process can be complicated and lengthy and involve numerous opportunities to enter incorrect data. Using a computer assisted interviewing instrument of the induction interview will allow FRs to skip unneeded questions, quickly populate write-in fields with drop-down menus, and eliminate the need for paper flash-cards that highlight item choices. In the end, we expect the time a respondent spends during the induction interview to be significantly reduced. Approval to collect Patient Record forms (PRFs) data through an automated instrument is also requested. Use of a computerized data entry system for PRF data will significantly simplify the data collection activities by reducing data entry errors and omissions, as well as providing on-screen look-up tables for items such as reason for visit, diagnosis, and medications. Overall, using a computerized data entry system should reduce FR and respondent burden, and ultimately improve overall data quality. In addition, collecting the data electronically will speed editing, transmission, and processing, thereby making release of the yearly statistics more timely.

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Annual Cost to Federal Government: $6,032,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Yes

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Yes

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 10/26/2011

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