Information Collection

Induction Interview - Service Delivery Site (NAMCS-201)

IC 220058 under ICR 202105-0920-006 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Induction Interview - Service Delivery Site (NAMCS-201)	Form and Instruction
2018 CHC Provider Induction Sample Card Induction Interview - Service Delivery Site (NAMCS-201)	Form and Instruction
2019 CHC Provider Induction Interview Induction Interview - Service Delivery Site (NAMCS-201)	Form and Instruction
CDC Service Delivery Induction Interview Sample Card 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

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:

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	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 %

table that charts list of burden
	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

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.