2012 Pretest NAMCS Patient Record Form (line 10)

National Ambulatory Medical Care Survey

OMB: 0920-0234

IC ID: 196407

Information Collection (IC) Details

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2012 Pretest NAMCS Patient Record Form (line 10)
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none Att BB - NAMCS 2012 - Patient Record Form CPT Code Pretest Att BB NAMCS Patient Record form (NAMCS-30)-CPT Code PRETEST.pdf Yes Yes Fillable Fileable

Health Immunization Management

Health Resources Utilization Statistics  49 FR 37693

17 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  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 510 0 493 0 0 17
Annual IC Time Burden (Hours) 119 0 115 0 0 4
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
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