NAMCS-201 CHC Service Delivery Induction

National Ambulatory Medical Care Survey

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.