National Hospital Ambulatory Medical Care Survey

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Ambulatory Unit Induction Interview 2021	Form and Instruction	New	Repair queued
Reinterview Study 2021	Form and Instruction	Modified	Available
Hospital Induction Interview 2021	Form and Instruction	Modified	Repair queued
Reinterview Study 2020	Form and Instruction	Modified	Available
Ambulatory Unit Induction Interview 2020	Form and Instruction	Modified	Available
Hospital Induction Interview 2020	Form and Instruction	Modified	Available
Attachment H2 - 2021 introductory letter 08.20.2020.pdf	Supplementary Document	Uploaded 2020-08-28	Available
Attachment H1 - 2020 introductory letter.pdf	Supplementary Document	Uploaded 2020-04-17	Available
Attachment J - Informed Consent flowsheet.docx	Supplementary Document	Uploaded 2020-04-08	Available
Attachment I - Endorsement letters.docx	Supplementary Document	Uploaded 2020-04-08	Repair queued
Attachment G2 - Waiver of Informed Consent.docx	Supplementary Document	Uploaded 2020-04-08	Available
Attachment G1 - IRB Approval letter.pdf	Supplementary Document	Uploaded 2020-04-08	Available
Attachment F - List of Consultants.docx	Supplementary Document	Uploaded 2020-04-08	Available
Attachment E - List of Publications.docx	Supplementary Document	Uploaded 2020-04-08	Available
Attachment D2 - ED PRF sample card (2021).pdf	Supplementary Document	Uploaded 2020-04-08	Available
Attachment D1 - ED PRF sample card (2020).pdf	Supplementary Document	Uploaded 2020-04-08	Available
Attachment B - 0920-0278 60-Day FRN (2020-01383).pdf	Supplementary Document	Uploaded 2020-04-08	Available
Attachment A - Applicable Laws and Regulations.pdf	Supplementary Document	Uploaded 2020-04-08	Available
NHAMCS SSB_03.24.2020.docx	Supporting Statement B	Uploaded 2020-04-08	Available
NHAMCS SSA 09.03.2020.docx	Supporting Statement A	Uploaded 2020-09-04	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
241281	Ambulatory Unit Induction Interview 2021	Form and Instruction	New
233076	Reinterview Study 2021	Form and Instruction	Modified
233075	Hospital Induction Interview 2021	Form and Instruction	Modified
214307	Retrieve Medical Records 2021	Instruction	Modified
214306	Reinterview Study 2020	Form and Instruction	Modified
214305	Retrieve Medical Records 2020	Instruction	Modified
214300	Ambulatory Unit Induction Interview 2020	Form and Instruction	Modified
214297	Hospital Induction Interview 2020	Form and Instruction	Modified

ICR Details

OMB Control No: 0920-0278	ICR Reference No: 202004-0920-006
Status: Active	Previous ICR Reference No: 201809-0920-005
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-0278
Title: National Hospital Ambulatory Medical Care Survey
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: 09/04/2020
	Date Received in OIRA: 04/17/2020
Terms of Clearance: Approved consistent with commitment to routinely brief OMB about progress merging with National Hospital Care Survey. COVID-19 related data elements may be added through non-sub changes. Please report to OMB on CDC/NCHS' consideration of the comments from the American Association of Nurse Practitioners.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2023	36 Months From Approved	06/30/2021
Responses	56,507	0	25,700
Time Burden (Hours)	1,500	0	788
Cost Burden (Dollars)	70,597	0	22,699

---

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. Questions regarding epidemic related changes in care have been added.

---

Authorizing Statute(s): US Code: 42 USC 306 Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 4990	01/28/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 21440	04/17/2020
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 8

table that charts list of burden

IC Title	Form No.	Form Name
Ambulatory Unit Induction Interview 2021	NA	2021 NHAMCS Ambulatory Unit Induction Questionnaire
Hospital Induction Interview 2021	NA	2021 NHAMCS Hospital Induction Questionnaire
Retrieve Medical Records 2020
Reinterview Study 2020	none	Reinterview Study 2020
Retrieve Medical Records 2021
Hospital Induction Interview 2020	none	Hospital induction questionnaire 2020
Reinterview Study 2021	none	Reinterview Study 2021
Ambulatory Unit Induction Interview 2020	none	Ambulatory Unit Induction Questionnaire 2020

---

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	56,507	25,700	0	30,807	0	0
Annual Time Burden (Hours)	1,500	788	0	712	0	0
Annual Cost Burden (Dollars)	70,597	22,699	0	47,898	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: We are requesting approval to complete the 2020 data collection which is currently underway and collect data over the following three years (2021-2023) without change to the current survey activities.

---

Annual Cost to Federal Government: $5,457,440

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]? 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? Yes

---

Common Form ICR:  No

---

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: 04/17/2020

---