Pulling and re-filing Medical Record Forms (FR abstracts)

National Ambulatory Medical Care Survey (NAMCS)

⚠️ Notice: This information collection may be referencing outdated material.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
Att H - 2016 PRF Burden 122115.docx Instruction
Att H - 2016 PRF Burden 122115.docx Att H - 2016 PRF Burden IC Document

Information Collection (IC) Details

IC Title:	Pulling and re-filing Medical Record Forms (FR abstracts)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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
Instruction			Att H - 2016 PRF Burden 122115.docx		Yes	Yes	Fillable Printable

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 37697

Number of Respondents: 2,201	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	Previously Approved
Annual Number of Responses for this IC	66,030	-165,840	231,870
Annual IC Time Burden (Hours)	1,101	-2,764	3,865
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Att H - 2016 PRF Burden	Att H - 2016 PRF Burden 122115.docx	02/10/2016

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