Information Collection

NAMCS-201 CHC Service Delivery Induction

IC 213883 under ICR 201411-0920-004 · OMB 0920-0234.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0234 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
NAMCS-201 CHC Service Delivery Induction	Form
CHC Induction Survey Att C5 - 2015 NAMCS-201 ListQ.docx	Form
Att C4 - 2015 NAMCS-201 Changes.docx NAMCS-201 Proposed Changes	IC Document

IC Title:

NAMCS-201 CHC Service Delivery Induction

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	CHC Induction Survey	Att C5 - 2015 NAMCS-201 ListQ.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: 09-20--0167 Health Resources Utilization Statistics

FR Citation: 49 FR 37693

Number of Respondents: 1,780

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,780	1,780
Annual IC Time Burden (Hours)	593	593
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
NAMCS-201 Proposed Changes	Att C4 - 2015 NAMCS-201 Changes.docx	11/13/2014

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.