National Ambulatory Medical Care Survey (NAMCS)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920-0234 Re-abstraction Study	Form and Instruction	New	Available
Form 0920-0234 Patient Record Form (NAMCS-1)	Form and Instruction	New	Available
Form 0920-0234 Induction Interview Providers (NAMCS-1)	Form and Instruction	New	Available
Form 0920-0234 Introduction Interview - Service Delivery Site (NAMCS-201)	Form and Instruction	New	Available
Form 0920-0234 Physician Abstracts -Patient Record Form (NAMCS-30)	Form and Instruction	Modified	Available
Form 0920-0234 Physician Induction Inverview (NAMCS-1)	Form and Instruction	Modified	Available
0920-0234 Supporting Statement B_012816.docx	Supporting Statement B	Uploaded 2016-02-10	Available
0920-0234 Supporting Statement A 012816.docx	Supporting Statement A	Uploaded 2016-02-10	Available
Att B2 Public Comment.txt	Supplementary Document	Uploaded 2016-02-10	Available
Att M - Endorsing Organizations.pdf	Supplementary Document	Uploaded 2016-02-09	Available
Att N - NAMCS Brochure.pdf	Supplementary Document	Uploaded 2016-02-09	Available
Att L - Advanced Letters FINAL.docx	Supplementary Document	Uploaded 2016-02-09	Available
Att K - 2015 Physicians by region.xls	Supplementary Document	Uploaded 2016-02-09	Available
Att J - 2015 Physicians by specialty.xls	Supplementary Document	Uploaded 2016-02-09	Available
Att F - 2016-2018 Consultants.docx	Supplementary Document	Uploaded 2016-02-09	Available
Att G IRB Approval Letter.pdf	Supplementary Document	Uploaded 2016-02-09	Available
Att A - Authorizing Legislation.pdf	Supplementary Document	Uploaded 2016-02-09	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
220064	Re-abstraction Study	Form and Instruction	New
220063	Patient Record Form (NAMCS-1)	Form and Instruction	New
220059	Induction Interview Providers (NAMCS-1)	Form and Instruction	New
220058	Introduction Interview - Service Delivery Site (NAMCS-201)	Form and Instruction	New
213885	Pulling, Re-Filing Medical Forms (FR abstracts)	Instruction	Modified
213884	Pulling and re-filing Medical Record Forms (FR abstracts)	Instruction	Modified
213883	Prepare and Transmit EHR (MU Onboarding)	Instruction	Modified
213882	Physician Abstracts -Patient Record Form (NAMCS-30)	Form and Instruction	Modified
213881	Physician Induction Inverview (NAMCS-1)	Form and Instruction	Modified

ICR Details

OMB Control No: 0920-0234	ICR Reference No: 201602-0920-006
Status: Historical Active	Previous ICR Reference No: 201411-0920-004
Agency/Subagency: HHS/CDC	Agency Tracking No: 20471
Title: National Ambulatory Medical Care Survey (NAMCS)
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: 03/14/2016
	Date Received in OIRA: 02/11/2016
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	03/31/2019	36 Months From Approved	12/31/2017
Responses	84,598	0	306,271
Time Burden (Hours)	5,435	0	25,311
Cost Burden (Dollars)	0	0	0

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Abstract: This revision package is submitted specifically to 1) continue survey activities for the 3 years 2016, 2017, and 2018, 2) discontinue the provision of state-based estimates, due to decreased funding 3) modify existing questions for clarification and to keep up-to-date with current medical practice and terminology, 4) add new questions on emerging health topics to regular data collection activities, 5) add new questions to the physician interview that pertain to policies, services, and experiences related to the prevention and treatment of sexually transmitted infections (STIs) and HIV prevention (STD/PrEP) and 6) include a small number of physicians who will prepare and transmit Electronic Health Records (EHRs) to fulfill Meaningful Use requirements.

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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

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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:
	80 FR 60908	10/08/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 7119	02/10/2016
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 9

table that charts list of burden

IC Title	Form No.	Form Name
Physician Induction Inverview (NAMCS-1)	0920-0234	Att C2 - 2016 NAMCS 1 TradPhys
Physician Abstracts -Patient Record Form (NAMCS-30)	0920-0234	Att D2 2016 NAMCS PRF 122115
Pulling, Re-Filing Medical Forms (FR abstracts)
Pulling and re-filing Medical Record Forms (FR abstracts)
Prepare and Transmit EHR (MU Onboarding)
Introduction Interview - Service Delivery Site (NAMCS-201)	0920-0234	Att C4- 2016 NAMCS-201
Induction Interview Providers (NAMCS-1)	0920-0234	Att C3- 2016 NAMCS 1 CHC 122115
Patient Record Form (NAMCS-1)	0920-0234	Att D2 2016 NAMCS PRF
Re-abstraction Study	0920-0234	Att C1 NAMCS-1A

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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	84,598	306,271	0	-221,673	0	0
Annual Time Burden (Hours)	5,435	25,311	0	-19,876	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 average total burden is estimated to be 5,435 hours, a net decrease of 19,876 hours. This reduction is primarily due to a sample size decrease as a result of reduced funding. However, there is the inclusion of a new activity, the transmission of electronic health records by physicians to fulfill meaning use requirements.

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Annual Cost to Federal Government: $8,392,113

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: 02/11/2016

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