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	Removed	Available
NAMCS-201 CHC Service Delivery Induction	Form	New	Repair queued
NAMCS-30 Patient Record Form	Form	New	Available
Physician Induction Inverview (NAMCS-1)	Form	New	Available
2012 Pretest NAMCS Patient Record Form (line 10)	Form	Removed	Available
2012 CPT Pretest NAMCS-1 (line 9)	Form	Removed	Available
Physician Workflow Survey (line 8)	Form	Removed	Available
National Electronic Health Records Survey (line 7)	Form	Removed	Available
2012 Asthma Supplement (line 6)	Form	Removed	Available
NAMCS-30 Patient Record form (Line 3)	Form	Removed	Available
NAMCS-201 Community Health Center Induction Interview (Line 2)	Form	Removed	Available
Att L - Advanced Letters.docx	Supplementary Document	Uploaded 2014-11-13	Available
Att N - NAMCS Brochure.pdf	Supplementary Document	Uploaded 2014-11-13	Available
Att M - Endorsing Organizations.pdf	Supplementary Document	Uploaded 2014-11-13	Available
Att K - 2015 Physicians by region.xls	Supplementary Document	Uploaded 2014-11-13	Available
Att J - 2015 Physicians by specialty.xls	Supplementary Document	Uploaded 2014-11-13	Available
Att G - IRB approval letter.pdf	Supplementary Document	Uploaded 2014-11-13	Available
Att F - 2015-2017 Consultants.docx	Supplementary Document	Uploaded 2014-11-13	Available
Att B - 60 day FRN.pdf	Supplementary Document	Uploaded 2014-11-13	Available
Att A - Authorizing Legislation.pdf	Supplementary Document	Uploaded 2014-11-13	Available
0920-0234 NAMCS SSB 110414.docx	Supporting Statement B	Uploaded 2014-11-13	Available
0920-0234 NAMCS SSA 110414.docx	Supporting Statement A	Uploaded 2014-11-13	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
43612	NAMCS-1 Physician Induction Interview (Line 1)	Form	Removed
213885	2015 Patient Record Form - Pulling and Refiling	Other-Burden Placeholder	New
213884	Re-abstraction Study: Pulling & Refiling Medical Records	Other-Burden Placeholder	New
213883	NAMCS-201 CHC Service Delivery Induction	Form	New
213882	NAMCS-30 Patient Record Form	Form	New
213881	Physician Induction Inverview (NAMCS-1)	Form	New
204682	Re-abstraction Study	Instruction	Removed
196407	2012 Pretest NAMCS Patient Record Form (line 10)	Form	Removed
196406	2012 CPT Pretest NAMCS-1 (line 9)	Form	Removed
196405	Physician Workflow Survey (line 8)	Form	Removed
196404	National Electronic Health Records Survey (line 7)	Form	Removed
196403	2012 Asthma Supplement (line 6)	Form	Removed
181891	Pulling and re-filing Patient Record form (Line 4)	Instruction	Removed
181890	NAMCS-30 Patient Record form (Line 3)	Form	Removed
181889	NAMCS-201 Community Health Center Induction Interview (Line 2)	Form	Removed

ICR Details

OMB Control No: 0920-0234	ICR Reference No: 201411-0920-004
Status: Historical Active	Previous ICR Reference No: 201309-0920-004
Agency/Subagency: HHS/CDC	Agency Tracking No: 20471
Title: National Ambulatory Medical Care Survey
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/19/2014
	Date Received in OIRA: 11/20/2014
Terms of Clearance: Improvements to the wording of the survey questions permitted through non-substantive change mechanism.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2017	36 Months From Approved	12/31/2014
Responses	306,271	0	553,650
Time Burden (Hours)	25,311	0	47,943
Cost Burden (Dollars)	0	0	0

---

Abstract: The National Ambulatory Medical Care Survey (NAMCS) is a nationally representative survey of patient visits to office-based physicians, conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics. This request is for continued survey activities for the next three years with some modifications. The annualized 2015-2017 NAMCS sample size is projected to be 12,085 office-based physicians and CHC providers. The amount of supplemental funding determines sample size, thus the number of state-level estimates that can be generated. Funding allowed 34 state estimates in 2012, 22 in 2013, and 18 in 2014. This year funding accommodates estimates for 16 states.

---

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

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 35161	06/19/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 68886	11/19/2014
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 5

table that charts list of burden

IC Title	Form No.	Form Name
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
Physician Induction Inverview (NAMCS-1)	none	NAMCS 1
NAMCS-30 Patient Record Form	none, none	NAMCS-30 Form ,   NAMCS-30 Card
2015 Patient Record Form - Pulling and Refiling
2012 Asthma Supplement (line 6)	none	Att B - Asthma Supplement
National Electronic Health Records Survey (line 7)	None	National Electronic Health Records Survey 2013
Re-abstraction Study: Pulling & Refiling Medical Records
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
Pulling and re-filing Patient Record form (Line 4)
NAMCS-201 CHC Service Delivery Induction	none	CHC Induction Survey

---

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	306,271	553,650	0	-247,379	0	0
Annual Time Burden (Hours)	25,311	47,943	0	-22,632	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The removal of NEHRS and pretests decreases burden and responses. In addition, the sample size is being cut slightly due to less supplementatal funding.

---

Annual Cost to Federal Government: $11,302,329

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

---

Common Form ICR:  No

---

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: 11/20/2014

---