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⚠️ Notice: This information collection may be referencing outdated material.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
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
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
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: Removed

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 %

	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	-116	116
Annual IC Time Burden (Hours)	-58	58
Annual IC Cost Burden (Dollars)	-5,250	5,250

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.