National Ambulatory Medical Care Survey (NAMCS)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Reinterview Study Questionnaire	Form and Instruction	Unchanged	Available
2019 CDC Provider Questions	Form and Instruction	Unchanged	Available
2018 CHC Provider Induction Sample Card	Form and Instruction	Unchanged	Available
Form 0920-0234 NAMCS Physician	Form and Instruction	Modified	Available
Sample 2019 Patient Record	Form	Modified	Available
2019 NAMCS-1 Questions for Traditional Physicians	Form and Instruction	Modified	Available
CDC Service Delivery Induction Interview Sample Card	Form and Instruction	Unchanged	Available
2019 CHC Provider Induction Interview	Form and Instruction	Unchanged	Available
2018 CHC Provider Induction Sample Card	Form and Instruction	Unchanged	Available
NAMCS-PFI Questions for MU Physicians	Form and Instruction	Unchanged	Available
2018Traditional Physician Induction Sample Card	Form and Instruction	Unchanged	Available
Attachment B 2020 NAMCS-1 Traditional Physician_062620.docx	Supplementary Document	Uploaded 2020-07-01	Available
Attachment C 2020 NAMCS-201 CHC Service Delivery_062620.docx	Supplementary Document	Uploaded 2020-07-01	Available
COVID19_OMB_Memo_NAMCS_062620.docx	Supplementary Document	Uploaded 2020-07-01	Available
Attachment A 2020 NAMCS Proposed COVID-19 Questions_062620.docx	Supplementary Document	Uploaded 2020-07-01	Repair queued
NAMCS COVID-19_Nonsubstanstive Change_30June2020.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2020-07-01	Available
Att R-2018 FAQs.pdf	Supplementary Document	Uploaded 2019-02-28	Available
Att O-Detailed Description of Burden Row Calculations.docx	Supplementary Document	Uploaded 2019-02-28	Available
Att M-Endorsing Organizations 010419.pdf	Supplementary Document	Uploaded 2019-02-28	Available
Att L-NAMCS Brochure 010419.pdf	Supplementary Document	Uploaded 2019-02-28	Available
Att K2-2019 NAMCS Advance Letters.pdf	Supplementary Document	Uploaded 2019-02-28	Available
Att K1-2018 NAMCS Advance Letters.pdf	Supplementary Document	Uploaded 2019-02-28	Repair queued
Att H-2019 ERB Approval Letter.pdf	Supplementary Document	Uploaded 2019-02-28	Available
Att D-2019-2021 Consultants.docx	Supplementary Document	Uploaded 2019-02-28	Available
Att B 60-day FRN 103018.docx	Supplementary Document	Uploaded 2019-02-28	Available
Att A-Authorizing Legislation 012519.pdf	Supplementary Document	Uploaded 2019-02-28	Available
0920-234 NAMCS SS Part B 05 15 19.docx	Supporting Statement B	Uploaded 2019-05-17	Available
0920-0234 NAMCS SS Part A 05 15 19.docx	Supporting Statement A	Uploaded 2019-05-17	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
235134	Reinterview Study - Traditional Physician and CHC Staff	Form and Instruction	Unchanged	Reinterview Study Questionnaire
235133	MU Physician Pulling and Refiling EHR	Instruction	Unchanged
235132	Induction Interview - Community Health Center Providers	Form and Instruction	Unchanged	2019 CDC Provider Questions
235132	Induction Interview - Community Health Center Providers	Form and Instruction	Unchanged	2018 CHC Provider Induction Sample Card
235132	Induction Interview - Community Health Center Providers	Instruction	Unchanged
220064	Reabstraction Study - Traditional and CHC Providers	Instruction	Unchanged
220059	2019 Traditional Provider Induction Interview (NAMCS-1)	Form and Instruction	Modified	NAMCS Physician
220059	2019 Traditional Provider Induction Interview (NAMCS-1)	Form	Modified	Sample 2019 Patient Record
220059	2019 Traditional Provider Induction Interview (NAMCS-1)	Form and Instruction	Modified	2019 NAMCS-1 Questions for Traditional Physicians
220059	2019 Traditional Provider Induction Interview (NAMCS-1)	Instruction	Modified
220058	Induction Interview - Service Delivery Site (NAMCS-201)	Form and Instruction	Unchanged	CDC Service Delivery Induction Interview Sample Card
220058	Induction Interview - Service Delivery Site (NAMCS-201)	Form and Instruction	Unchanged	2019 CHC Provider Induction Interview
220058	Induction Interview - Service Delivery Site (NAMCS-201)	Form and Instruction	Unchanged	2018 CHC Provider Induction Sample Card
213885	Pulling and Refiling Medical Record Forms - CHC Provider and Staff	Instruction	Unchanged
213884	Pulling and Refiling Medical Record Forms - Tradtional Providers	Instruction	Unchanged
213883	MU Physician Induction Interview	Form and Instruction	Unchanged	NAMCS-PFI Questions for MU Physicians
213881	2018 Physician Induction Inverview (NAMCS-1)	Form and Instruction	Unchanged	2018Traditional Physician Induction Sample Card

ICR Details

OMB Control No: 0920-0234	ICR Reference No: 202007-0920-001
Status: Historical Active	Previous ICR Reference No: 201902-0920-021
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-0234
Title: National Ambulatory Medical Care Survey (NAMCS)
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/01/2020
Retrieve Notice of Action (NOA)	Date Received in OIRA: 07/01/2020
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2022	05/31/2022	05/31/2022
Responses	46,013	0	46,013
Time Burden (Hours)	5,038	0	5,038
Cost Burden (Dollars)	179,568	0	179,568

---

Abstract: The goal of NAMCS is to assess the health of the US population through patient use of physician offices and community health centers and to monitor the characteristics of physician practices. This request is to continue survey activities for 2019, 2020, & 2021; revisions include discontinue prevention & treatment of sexually transmitted infections (STIs) & HIV (STD/PrEP) prevention questions, culturally & linguistically appropriate service questions, & alcohol & substance abuse screening & brief intervention questions; modify questions for clarification and to keep with current medical practice & terminology; update how race/ethnicity are asked on NAMCS induction forms; follow the DHHS guidance on data collection standards for race/ethnicity for self-identification; increase the sample size for survey years 2020 & 2021;discontinue reabstraction of patient visits; conduct reinterview study for 2019-2021. The June 2020 non-substantive change request is to add questions about changes in practices that might have been spurred by the COVID-19 pandemic. response, including use of telemedicine.

---

Authorizing Statute(s): PL: Pub.L. 111 - 5 1512 Name of Law: American Recovery and Reinvestment Act of 2009
   US Code: 42 USC 242K 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:
	83 FR 39755	08/10/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 10089	03/19/2019
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 10

table that charts list of burden

IC Title	Form No.	Form Name
2018 Physician Induction Inverview (NAMCS-1)	none	2018Traditional Physician Induction Sample Card
2019 Traditional Provider Induction Interview (NAMCS-1)	none, none, 0920-0234	2019 NAMCS-1 Questions for Traditional Physicians ,   Sample 2019 Patient Record ,   NAMCS Physician
Induction Interview - Community Health Center Providers	none, none	2018 CHC Provider Induction Sample Card ,   2019 CDC Provider Questions
Induction Interview - Service Delivery Site (NAMCS-201)	none, none, none	2018 CHC Provider Induction Sample Card ,   2019 CHC Provider Induction Interview ,   CDC Service Delivery Induction Interview Sample Card
MU Physician Induction Interview	none	NAMCS-PFI Questions for MU Physicians
MU Physician Pulling and Refiling EHR
Pulling and Refiling Medical Record Forms - CHC Provider and Staff
Pulling and Refiling Medical Record Forms - Tradtional Providers
Reabstraction Study - Traditional and CHC Providers
Reinterview Study - Traditional Physician and CHC Staff	none	Reinterview Study Questionnaire

---

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	46,013	46,013	0	0	0	0
Annual Time Burden (Hours)	5,038	5,038	0	0	0	0
Annual Cost Burden (Dollars)	179,568	179,568	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government: $9,313,341

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: 07/01/2020

---