National Ambulatory Medical Care Survey

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
NAMCS-1 Physician Induction Interview (Line 1)	Form	Modified	Available
2012 Pretest NAMCS Patient Record Form (line 10)	Form	Modified	Available
2012 CPT Pretest NAMCS-1 (line 9)	Form	Modified	Available
Physician Workflow Survey (line 8)	Form	Modified	Available
National Electronic Health Records Survey (line 7)	Form	Modified	Available
2012 Asthma Supplement (line 6)	Form	Modified	Available
Lookback Module (Line 5)	Form	Modified	Available
NAMCS-30 Patient Record form (Line 3)	Form	Modified	Available
NAMCS-201 Community Health Center Induction Interview (Line 2)	Form	Modified	Available
Attachment H.docx	Supplementary Document	Uploaded 2012-10-17	Available
Attachment G.docx	Supplementary Document	Uploaded 2012-10-17	Available
NAMCS 2012 nonsub just doc 092812 rev 101612.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2012-10-17	Available
Att AA Changes to NAMCS-1 and NAMCS-201 Items for Survey Year 2012 CPT Code PRETEST.PDF	Supplementary Document	Uploaded 2011-11-07	Available
Att M Item modifications on the National EHR Survey 2012 from the 2011 EMRS.pdf	Supplementary Document	Uploaded 2011-11-07	Available
Att J NAMCS-1 EHR items and list of modifications.pdf	Supplementary Document	Uploaded 2011-11-07	Available
Att DD 2012 NAMCS Re-abstraction Study Lookback Module.pdf	Supplementary Document	Uploaded 2011-12-12	Available
Att EE 2012 NAMCS Re-abstraction Study Pulling and Re-filing.pdf	Supplementary Document	Uploaded 2011-12-12	Available
Att CC NAMCS 2012 Re-abstraction Study Patient Record Form.pdf	Supplementary Document	Uploaded 2011-12-12	Available
Att I Changes to the PRF from 2011 to 2012.pdf	Supplementary Document	Uploaded 2011-11-07	Available
Att D CAM definitions.pdf	Supplementary Document	Uploaded 2011-11-07	Available
Att G Changes to NAMCS-1 and NAMCS-201 Items for Survey Year 2012.pdf	Supplementary Document	Uploaded 2011-11-07	Available
Att C CAM.PDF	Supplementary Document	Uploaded 2011-11-07	Available
NAMCS 2013 nonsub sup st rev 092812 (2)rev 100212.doc	Supporting Statement A	Uploaded 2012-10-17	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
43612	NAMCS-1 Physician Induction Interview (Line 1)	Form	Modified
204682	Re-abstraction Study	Instruction	New
196407	2012 Pretest NAMCS Patient Record Form (line 10)	Form	Modified
196406	2012 CPT Pretest NAMCS-1 (line 9)	Form	Modified
196405	Physician Workflow Survey (line 8)	Form	Modified
196404	National Electronic Health Records Survey (line 7)	Form	Modified
196403	2012 Asthma Supplement (line 6)	Form	Modified
189597	Lookback Module (Line 5)	Form	Modified
181891	Pulling and re-filing Patient Record form (Line 4)	Instruction	Modified
181890	NAMCS-30 Patient Record form (Line 3)	Form	Modified
181889	NAMCS-201 Community Health Center Induction Interview (Line 2)	Form	Modified

ICR Details

OMB Control No: 0920-0234	ICR Reference No: 201211-0920-001
Status: Historical Active	Previous ICR Reference No: 201111-0920-001
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: National Ambulatory Medical Care Survey
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/07/2012
	Date Received in OIRA: 11/01/2012
Terms of Clearance: Proir terms continue: New modules must be submitted to OMB for approval as substantive changes unless they were covered in the original supporting statement (e.g., moving prior modules in; cycling current modules out).

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2014	12/31/2014	12/31/2014
Responses	571,530	0	528,615
Time Burden (Hours)	50,923	0	46,622
Cost Burden (Dollars)	0	0	0

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Abstract: The National Ambulatory Medical Care Survey includes data collected from office-based physicians, and community health center providers. The National Electronic Health Records Survey (NEHRS), and the Physician Workflow Survey are also part of this project. . Several questions will be modified on physician information and on data on electronic medical records and physicians who have/have not adopted the use of these records.

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Authorizing Statute(s): US Code: 42 USC 242K Name of Law: Public Health Service Act
   PL: Pub.L. 111 - 5 1512 Name of Law: American Recovery and Reinvestment Act of 2009
  

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

Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 11

table that charts list of burden

IC Title	Form No.	Form Name
NAMCS-1 Physician Induction Interview (Line 1)	None	National Ambulatory Medical Care Survey 2013 Panel
NAMCS-201 Community Health Center Induction Interview (Line 2)	none	Att K - Community Health Center Induction Interview
NAMCS-30 Patient Record form (Line 3)	None	National Ambulatory Medical Care Survey 2013 Medical Record Form
Pulling and re-filing Patient Record form (Line 4)
Lookback Module (Line 5)	None	National Ambulatory Medical Care Survey 2013 Look Back Module
2012 Asthma Supplement (line 6)	none	Att B - Asthma Supplement
National Electronic Health Records Survey (line 7)	None	National Electronic Health Records Survey 2013
Physician Workflow Survey (line 8)	None, None	E. Physician Workflow Survey Year 2013 (EHR adopters) ,   F. Physician Workflow Survey Year 2013 (EHR nonadopters)
2012 CPT Pretest NAMCS-1 (line 9)	none	Att Z - NAMCS 2011 Panel CPT Code Pretest
2012 Pretest NAMCS Patient Record Form (line 10)	none	Att BB - NAMCS 2012 - Patient Record Form CPT Code Pretest
Re-abstraction Study

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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	571,530	528,615	0	42,915	0	0
Annual Time Burden (Hours)	50,923	46,622	0	4,301	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: No

Burden Reduction Due to:

Short Statement: This document proposes some new, reinstated, and modified questions to the prior approved NAMCS data collection content by survey form. New and modified content for 2013 is presented in the included attachments highlighted below and described in more detail in section A2.

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Annual Cost to Federal Government: $11,399,149

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? No

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: 11/01/2012

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