National Hospital Care Survey

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Initial Hospital Intake Questionnaire	Form	Modified	Repair queued
Annual FSASC Interview	Form	Removed	Available
Ambulatory Unit Induction	Form	Removed	Available
Annual Ambulatory Hospital Interview	Form	Modified	Available
Annual Inpatient Hospital Interview	Form	Modified	Available
Attachment M- ERB Approval Notice for NHCS.pdf	Supplementary Document	Uploaded 2014-09-04	Available
NHCS 2014 - 2016 Supporting Statement Part A_Final 08 28 14.docx	Supporting Statement A	Uploaded 2014-08-29	Available
Attachment S - NHCS FAQ Brochure.pdf	Supplementary Document	Uploaded 2014-08-21	Available
Attachment Q - Emergency Department Patient Record Form.docx	Supplementary Document	Uploaded 2014-08-21	Available
Attachment V - OPD PRF Changes.docx	Supplementary Document	Uploaded 2014-08-18	Available
Attachment U - ED PRF Changes.docx	Supplementary Document	Uploaded 2014-08-18	Available
Attachment T - Hospital Ambulatory Interview Changes.docx	Supplementary Document	Uploaded 2014-08-18	Available
Attachment M - ERB Approval Notice for NHCS.pdf	Supplementary Document	Uploaded 2014-08-18	Available
Attachment L - Westat Data Security Plan.pdf	Supplementary Document	Uploaded 2014-08-18	Available
Attachment I - List of Variables for EHR Extraction of OPD Visits.docx	Supplementary Document	Uploaded 2014-08-18	Available
Attachment H - List of Variables for EHR Extraction of ED Visits.docx	Supplementary Document	Uploaded 2014-08-18	Available
Attachment G - List of Variables for EHR Extraction of IP Discharges.docx	Supplementary Document	Uploaded 2014-08-18	Available
Attachment F - List of UB04 Data Elements.docx	Supplementary Document	Uploaded 2014-08-18	Available
Attachment E - Ambulatory Intro Letter to Hospitals EDs OPDs.docx	Supplementary Document	Uploaded 2014-08-18	Available
Attachment D - Introductory Letter to Hospitals.docx	Supplementary Document	Uploaded 2014-08-18	Available
Attachment C - NHCS Data Collection Flow Chart.docx	Supplementary Document	Uploaded 2014-08-18	Available
Attachment B - Federal Register Notice for NHCS.pdf	Supplementary Document	Uploaded 2014-08-18	Available
NHCS 2014 - 2016 Supporting Statement Part B_Final_Atlanta073014.docx	Supporting Statement B	Uploaded 2014-08-18	Available
Attachment A - Legislative Authority to Collect Data on Hospital Utilization.rtf	Supplementary Document	Uploaded 2013-01-30	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
6666	Initial Hospital Intake Questionnaire	Form	Modified
212757	Prepare and Transmit EHR for Inpatient and Ambulatory	Instruction	New
205650	FSASC Pulling and Refiling Patient Records	Instruction	Removed
205649	FSASC Prepare and Transmit UB-40	Instruction	Removed
205648	Annual FSASC Interview	Form	Removed
205647	Pulling and re-filing Patient Records (ED, OPD, and ASL)	Instruction	Removed
186285	Prepare and transmit UB-04 for Inpatient and Ambulatory	Instruction	Modified
186284	Ambulatory Unit Induction	Form	Removed
186283	Annual Ambulatory Hospital Interview	Form	Modified
186282	Annual Inpatient Hospital Interview	Form	Modified
186281	Recruitment Survey Presentation	Instruction	Modified

ICR Details

OMB Control No: 0920-0212	ICR Reference No: 201408-0920-007
Status: Historical Inactive	Previous ICR Reference No: 201302-0920-001
Agency/Subagency: HHS/CDC	Agency Tracking No: 18672
Title: National Hospital Care Survey
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Withdrawn and continue	Conclusion Date: 12/19/2014
	Date Received in OIRA: 09/12/2014
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2016	36 Months From Approved	04/30/2016
Responses	131,516	0	131,516
Time Burden (Hours)	7,224	0	7,224
Cost Burden (Dollars)	0	0	0

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Abstract: The National Center for Health Statistics (NCHS) requests approval to continue the National Hospital Care Survey (NHCS) which integrates the National Hospital Ambulatory Medical Care Survey (NHAMCS) (OMB No. 0920-0278) and the Drug-Abuse Warning Network (DAWN) (OMB No. 0930-0078, expired 12/31/2011) previously conducted by the Substance Abuse and Mental Health Services Administration's (SAMHSA). Integration of NHAMCS and DAWN into the NHCS is part of a broader strategy to improve efficiency by minimizing redundancy in data collection; broadening our capability to collect more relevant data on transitions of care; and identifying opportunities to explore electronic and administrative clinical data systems to augment primary data collection. NHCS currently collects Uniform Bill (UB) 04 administrative claims data electronically but as more hospitals adopt electronic health records (EHRs), EHR file extraction will become the preferred method of data collection.

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Authorizing Statute(s): US Code: 42 USC 242k 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:
	78 FR 14709	03/17/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 49517	08/21/2014
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 6

table that charts list of burden

IC Title	Form No.	Form Name
Annual Ambulatory Hospital Interview	none	Annual Ambulatory Hospital Interview
Prepare and transmit UB-04 for Inpatient and Ambulatory
Pulling and re-filing Patient Records (ED, OPD, and ASL)
Annual FSASC Interview	none	Annual FSASC Interview
FSASC Prepare and Transmit UB-40
FSASC Pulling and Refiling Patient Records
Prepare and Transmit EHR for Inpatient and Ambulatory
Ambulatory Unit Induction	none	Ambulatory Unit Induction
Initial Hospital Intake Questionnaire	none	Initial Hospital Intake Questionnaire
Recruitment Survey Presentation
Annual Inpatient Hospital Interview	none	Annual Hospital Interview

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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: Miscellaneous Actions

Short Statement: Burden changes are due to increases due to change to monthly data transmission for UB-40 claims and the addition of 81 hospitals. Reductions are due to changes to some forms, as well as combining some previous forms into other existing forms. Pulling and refilling some patient records has been eliminated as we only use electronic abstraction now. Free standing ambulatory surgery centers were removed from the design of the survey.

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Annual Cost to Federal Government: $9,173,000

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? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

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)? No

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: 09/12/2014

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