Information Collection

2019 Traditional Provider Induction Interview (NAMCS-1)

IC 220059 under ICR 201902-0920-021 · OMB 0920-0234.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
2019 Traditional Provider Induction Interview (NAMCS-1)	Form and Instruction
Att C3-2019 Induction Sample Card TradPhy.docx	Instruction
2019 NAMCS-1 Questions for Traditional Physicians Att C1-2019 NAMCS 1 TradPhys 012519.docx	Form and Instruction
Sample 2019 Patient Record Att F-2019 Patient Record Form (NAMCS-73).pdf	Form

IC Title:

2019 Traditional Provider Induction Interview (NAMCS-1)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	none	2019 NAMCS-1 Questions for Traditional Physicians	Att C1-2019 NAMCS 1 TradPhys 012519.docx	Yes	Yes	Fillable Fileable
Instruction			Att C3-2019 Induction Sample Card TradPhy.docx	Yes	Yes	Fillable Fileable
Form	none	Sample 2019 Patient Record	Att F-2019 Patient Record Form (NAMCS-73).pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Human Resources Utilization 09-20-0167

FR Citation: 49 FR 37697

Number of Respondents: 1,097

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 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,097	863	234
Annual IC Time Burden (Hours)	549	432	117
Annual IC Cost Burden (Dollars)	17,640	17,640	0

Documents for IC

table that charts IC Documents
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.