NAMCS-30 Patient Record form (Line 3)

National Ambulatory Medical Care Survey

OMB: 0920-0234

IC ID: 181890

Information Collection (IC) Details

View Information Collection (IC)

NAMCS-30 Patient Record form (Line 3)
 
No Removed
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none Patient Record Form NAMCS 2014 Attachment D 082713.docx Yes Yes Fillable Fileable

Health Immunization Management

09-20-0167 Health Resources Utilization Statistics  49 FR 37693

3,407 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 0 0 -102,210 0 0 102,210
Annual IC Time Burden (Hours) 0 0 -23,849 0 0 23,849
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
B - Changes to Patient Record Form Attachment B.docx 09/04/2013
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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