Induction Interview - Service Delivery Site (NAMCS-201)

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⚠️ Notice: This information collection may be referencing outdated material.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
Induction Interview - Service Delivery Site (NAMCS-201) Form and Instruction
2018 CHC Provider Induction Sample Card Att C5-2018 Induction Sample Card CHC Prov.pdf Form and Instruction
2019 CHC Provider Induction Interview Att E1-2019 NAMCS-201 CHC.docx Form and Instruction
CDC Service Delivery Induction Interview Sample Card Att E2-2019 NAMCS-201 CHC Service Delivery.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Induction Interview - Service Delivery Site (NAMCS-201)	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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	none	2018 CHC Provider Induction Sample Card	Att C5-2018 Induction Sample Card CHC Prov.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	none	2019 CHC Provider Induction Interview	Att E1-2019 NAMCS-201 CHC.docx	Yes	Yes	Fillable Fileable
Form and Instruction	none	CDC Service Delivery Induction Interview Sample Card	Att E2-2019 NAMCS-201 CHC Service Delivery.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Health Resources Utilzation 09-20-0167	FR Citation: 49 FR 37697

Number of Respondents: 116	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: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	116	12	104
Annual IC Time Burden (Hours)	58	6	52
Annual IC Cost Burden (Dollars)	5,250	5,250	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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