National Hospital Ambulatory Medical Care Survey

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920-0278 2016 Ambulatory Surgery Center Patient Record Form	Form and Instruction	Removed	Available
Form 0920-0278 2016 Outpatient Department Patient Record Form	Form and Instruction	Removed	Repair queued
Form 0920-0278 2016 Emergency Department Patient Record Form	Form and Instruction	Removed	Available
Ambulatory Unit Induction Interview 2018	Form and Instruction	Modified	Available
Hospital Induction Interview 2018	Form and Instruction	Modified	Repair queued
Attachment J - Emergency Department Patient Record Form 060118.docx	Supplementary Document	Uploaded 2018-06-04	Repair queued
Attachment G - Endorsement letters.pdf	Supplementary Document	Uploaded 2018-04-05	Available
Attachment F.2 - Reabstraction letter.pdf	Supplementary Document	Uploaded 2018-04-05	Available
Attachment F.1 - Introductory letter.pdf	Supplementary Document	Uploaded 2018-04-05	Available
Attachment E - CDC #2016-04 IRB Approval for Continuation of Protocol.pdf	Supplementary Document	Uploaded 2018-04-05	Available
Attachment D - List of Consultants.pdf	Supplementary Document	Uploaded 2018-04-05	Available
Attachment C - List of publications.pdf	Supplementary Document	Uploaded 2018-04-05	Available
Attachment B.1 - 0920-0278 60-day FRN 112717.pdf	Supplementary Document	Uploaded 2018-04-05	Available
Attachment A - Applicable Laws and Regulations.pdf	Supplementary Document	Uploaded 2018-04-05	Available
NHAMCS 2018-2020 Supporting Stat B 051118.docx	Supporting Statement B	Uploaded 2018-06-04	Available
NHAMCS 2018-2020 Supporting Stat A 051118.docx	Supporting Statement A	Uploaded 2018-06-04	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
214307	Retrieve Medical Records Records (Reabstraction)	Instruction	Modified
214306	Reabstraction Telephone Call	Instruction	Modified
214305	Retrieve Medical Records	Instruction	Modified
214304	2016 Ambulatory Surgery Center Patient Record Form	Form and Instruction	Removed
214303	2016 Outpatient Department Patient Record Form	Form and Instruction	Removed
214302	2016 Emergency Department Patient Record Form	Form and Instruction	Removed
214300	Ambulatory Unit Induction Interview 2018	Form and Instruction	Modified
214297	Hospital Induction Interview 2018	Form and Instruction	Modified

ICR Details

OMB Control No: 0920-0278	ICR Reference No: 201804-0920-001
Status: Historical Active	Previous ICR Reference No: 201510-0920-005
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-0278
Title: National Hospital Ambulatory Medical Care Survey
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/07/2018
	Date Received in OIRA: 04/20/2018
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2021	36 Months From Approved
Responses	37,825	0	0
Time Burden (Hours)	1,016	0	0
Cost Burden (Dollars)	42,570	0	0

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Abstract: The National Hospital Ambulatory Medical Care Survey (NHAMCS) data are widely used by all agencies of the Public Health Service and other government, academic, and private research organizations in tracking changes in hospital-based ambulatory health care. These data complement those from NAMCS (OMB No. 0920-0234, Exp. Date 03/31/2019) to provide a complete description of ambulatory health care utilization in the United States.

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Authorizing Statute(s): US Code: 42 USC 306 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:
	82 FR 56027	11/27/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 17417	04/19/2018
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 5

table that charts list of burden

IC Title	Form No.	Form Name
Retrieve Medical Records
Ambulatory Unit Induction Interview 2018	none	Ambulatory Unit Induction Interview
Reabstraction Telephone Call
Retrieve Medical Records Records (Reabstraction)
Hospital Induction Interview 2018	none, none	Hospital Induction Interview
2016 Emergency Department Patient Record Form	0920-0278	Attachment B - 2016 NHAMCS ED PRF Changes
2016 Outpatient Department Patient Record Form	0920-0278	Attachment C - 2016 NHAMCS OPD PRF Changes
2016 Ambulatory Surgery Center Patient Record Form	0920-0278	Attachment D - 2016 NHAMCS ASL PRF Changes

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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	37,825	0	0	48,025	-10,200	0
Annual Time Burden (Hours)	1,016	0	0	2,742	-1,726	0
Annual Cost Burden (Dollars)	42,570	0	0	42,570	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: No

Burden Reduction Due to:

Short Statement: Due to budget constraints, NCHS plans to implement only the ED component of the survey with the 2018 collection, ending the OPD and ASL settings after the 2017 collection is completed. This results in a reduction in the estimated annual burden from 4298 to 1251 hours.

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Annual Cost to Federal Government: $5,227,440

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Yes

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: 04/20/2018

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