National Ambulatory Medical Care Survey

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
NAMCS-1 Induction Interview	Form	Modified	Available
Att BB - NAMCS 2012 - Patient Record Form CPT Code Pretest	Form	Modified	Available
Att Z - NAMCS 2011 Panel CPT Code Pretest	Form	Modified	Available
F. Physician Workflow Survey Year 2013 (EHR nonadopters)	Form	Modified	Available
E. Physician Workflow Survey Year 2013 (EHR adopters)	Form	Modified	Repair queued
National Electronic Health Records Survey 2013	Form	Modified	Available
Att B - Asthma Supplement	Form	Modified	Available
National Ambulatory Medical Care Survey 2013 Look Back Module	Form	Removed	Available
Patient Record Form	Form	Modified	Available
Att K - Community Health Center Induction Interview	Form	Modified	Available
Attachment A4 102513.docx	Supplementary Document	Uploaded 2013-11-04	Available
NAMCS 2014 Nonsubstantive Change 102513.doc	Justification for No Material/Nonsubstantive Change	Uploaded 2013-11-04	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	Repair queued
Attachment B.docx	Supplementary Document	Uploaded 2013-09-04	Available
Attachment C2.docx	Supplementary Document	Uploaded 2013-09-04	Available
Attachment A1.docx	Supplementary Document	Uploaded 2013-09-04	Available
Attachemnt A2.docx	Supplementary Document	Uploaded 2013-09-04	Available
Attachemnt A3.docx	Supplementary Document	Uploaded 2013-09-04	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
43612	NAMCS-1 Physician Induction Interview (Line 1)	Form	Modified	NAMCS-1 Induction Interview
204682	Re-abstraction Study	Instruction	Modified
196407	2012 Pretest NAMCS Patient Record Form (line 10)	Form	Modified	Att BB - NAMCS 2012 - Patient Record Form CPT Code Pretest
196406	2012 CPT Pretest NAMCS-1 (line 9)	Form	Modified	Att Z - NAMCS 2011 Panel CPT Code Pretest
196405	Physician Workflow Survey (line 8)	Form	Modified	F. Physician Workflow Survey Year 2013 (EHR nonadopters)
196405	Physician Workflow Survey (line 8)	Form	Modified	E. Physician Workflow Survey Year 2013 (EHR adopters)
196404	National Electronic Health Records Survey (line 7)	Form	Modified	National Electronic Health Records Survey 2013
196403	2012 Asthma Supplement (line 6)	Form	Modified	Att B - Asthma Supplement
189597	Lookback Module (Line 5)	Form	Removed	National Ambulatory Medical Care Survey 2013 Look Back Module
181891	Pulling and re-filing Patient Record form (Line 4)	Instruction	Modified
181890	NAMCS-30 Patient Record form (Line 3)	Form	Modified	Patient Record Form
181889	NAMCS-201 Community Health Center Induction Interview (Line 2)	Form	Modified	Att K - Community Health Center Induction Interview

ICR Details

OMB Control No: 0920-0234	ICR Reference No: 201309-0920-004
Status: Historical Active	Previous ICR Reference No: 201211-0920-001
Agency/Subagency: HHS/CDC	Agency Tracking No: 20471
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: 11/04/2013
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/10/2013
Terms of Clearance:

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	553,650	0	571,530
Time Burden (Hours)	47,943	0	50,923
Cost Burden (Dollars)	0	0	0

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Abstract: This request is for a nonsubstantive change to modify selected sections of the 2012-2014 National Ambulatory Medical Care Survey to colelct new and/or updated information. Minor changes have been made to two survey insturments, and one module (the lookback) was removed.

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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: 10

table that charts list of burden

IC Title	Form No.	Form Name
2012 Asthma Supplement (line 6)	none	Att B - Asthma Supplement
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
Lookback Module (Line 5)	None	National Ambulatory Medical Care Survey 2013 Look Back Module
NAMCS-1 Physician Induction Interview (Line 1)	none	NAMCS-1 Induction Interview
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	Patient Record Form
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)
Pulling and re-filing Patient Record form (Line 4)
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	553,650	571,530	0	-17,880	0	0
Annual Time Burden (Hours)	47,943	50,923	0	-2,980	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

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

Burden Reduction Due to: Miscellaneous Actions

Short Statement: One module (lookback) was removed.

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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: 09/10/2013

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