Pulling and re-filing Patient Record form (Line 4)

Attachment T: Pulling and Re-filing Medical Records

Assurance of confidentiality-All information which would permit identification of an individual, a
practice, or an establishment will be held confidential; will be used for statistical purposes only by NCHS
staff, contractors, and agents only when required and with necessary controls; and will not be disclosed or
released to other persons without the consent of the individual or the establishment in accordance with
section 308(d) of the Public Health Service Act (42 USC 242m) and the Confidential Information
Protection and Statistical Efficiency Act (PL-107-347).
Notice – Public reporting burden for this collection of information is estimated to average 1 minute per
response, including time for reviewing instructions, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the collection of information. Any agency
may not conduct or sponsor, and a person is not required to respond to, a collection of information unless
it displays a current valid OMB control number. Send comments regarding this burden estimate or any
other aspect of this collection of information, including suggestions for reducing burden to: CDC/ATSDR
Information Collection Review Office, 1600 Clifton Road, MS D-74, Atlanta, GA 30333, ATTN: PRA
(0920-0234).

Based on 2009 data, we estimate that approximately 12,989 physicians/CHC providers will
participate in NAMCS, but will ask Census abstractors to complete the Patient Record
forms. The average burden for these special study/pretest respondents is one minute for
each form, which includes simply pulling and re-filing the medical records. Each office
submits forms on about thirty patients, which makes the total burden for each office
approximately thirty minutes.