Information Collection

2019 Traditional Provider Induction Interview (NAMCS-1)

IC 220059 under ICR 202007-0920-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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

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
0920-0234 NAMCS Physician Attachment B 2020 NAMCS-1 Traditional Physician_062620.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

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:

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
Form and Instruction	0920-0234	NAMCS Physician	Attachment B 2020 NAMCS-1 Traditional Physician_062620.docx	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 %

	Approved	Previously Approved
Annual Number of Responses for this IC	1,097	1,097
Annual IC Time Burden (Hours)	549	549
Annual IC Cost Burden (Dollars)	17,640	17,640

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.