National Hospital Ambulatory Medical Care Survey

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920-22BT Attachment E - Ambulatory Unit Induction Questionnaire (2022)	Form and Instruction	Modified	Available
Form 0920-22BT Ambulatory Unit Induction Interview 2022	Form and Instruction	Modified	Repair queued
Reinterview Study 2021	Form and Instruction	Unchanged	Available
Reinterview Study 2021	Form and Instruction	Unchanged	Repair queued
Form 0920-22BT Attachment D - Hospital Induction Questionnaire (2022)	Form and Instruction	Modified	Available
2021 NHAMCS Hospital Induction Questionnaire	Form and Instruction	Modified	Available
Hospital Induction Interview 2022	Form and Instruction	Modified	Repair queued
Reinterview Study 2020	Form and Instruction	Unchanged	Available
Reinterview Study 2020	Form and Instruction	Unchanged	Repair queued
Ambulatory Unit Induction Questionnaire 2020	Form and Instruction	Unchanged	Available
Ambulatory Unit Induction Interview 2020	Form and Instruction	Unchanged	Repair queued
Hospital induction questionnaire 2020	Form and Instruction	Unchanged	Available
Hospital Induction Interview 2020	Form and Instruction	Unchanged	Repair queued
Attachment A - 2022 NHAMCS Hospital Induction Changes.docx	Supplementary Document	Uploaded 2022-01-26	Repair queued
Attachment B - 2022 NHAMCS Ambulatory Unit Induction Changes.docx	Supplementary Document	Uploaded 2022-01-26	Repair queued
Attachment C - 2022 ED Patient Record Form (PRF) Changes.docx	Supplementary Document	Uploaded 2022-01-26	Available
Summary Table of the Questionnaire Changes.docx	Supplementary Document	Uploaded 2022-01-26	Repair queued
2022 NHAMCS OMB Non-substantive Final 01052022v2.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2022-01-26	Repair queued
Attachment H2 - 2021 introductory letter 08.20.2020.pdf	Supplementary Document	Uploaded 2020-08-28	Repair queued
Attachment H1 - 2020 introductory letter.pdf	Supplementary Document	Uploaded 2020-04-17	Repair queued
Attachment J - Informed Consent flowsheet.docx	Supplementary Document	Uploaded 2020-04-08	Repair queued
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	Repair queued
Attachment F - List of Consultants.docx	Supplementary Document	Uploaded 2020-04-08	Repair queued
Attachment E - List of Publications.docx	Supplementary Document	Uploaded 2020-04-08	Repair queued
Attachment D2 - ED PRF sample card (2021).pdf	Supplementary Document	Uploaded 2020-04-08	Repair queued
Attachment D1 - ED PRF sample card (2020).pdf	Supplementary Document	Uploaded 2020-04-08	Repair queued
Attachment B - 0920-0278 60-Day FRN (2020-01383).pdf	Supplementary Document	Uploaded 2020-04-08	Repair queued
Attachment A - Applicable Laws and Regulations.pdf	Supplementary Document	Uploaded 2020-04-08	Repair queued
NHAMCS SSB_03.24.2020.docx	Supporting Statement B	Uploaded 2020-04-08	Repair queued
NHAMCS SSA 09.03.2020.docx	Supporting Statement A	Uploaded 2020-09-04	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
241281	Ambulatory Unit Induction Interview 2022	Form and Instruction	Modified	Attachment E - Ambulatory Unit Induction Questionnaire (2022)
241281	Ambulatory Unit Induction Interview 2022	Form and Instruction	Modified
233076	Reinterview Study 2021	Form and Instruction	Unchanged	Reinterview Study 2021
233076	Reinterview Study 2021	Form and Instruction	Unchanged
233075	Hospital Induction Interview 2022	Form and Instruction	Modified	Attachment D - Hospital Induction Questionnaire (2022)
233075	Hospital Induction Interview 2022	Form and Instruction	Modified	2021 NHAMCS Hospital Induction Questionnaire
233075	Hospital Induction Interview 2022	Form and Instruction	Modified
214307	Retrieve Medical Records 2021	Instruction	Unchanged
214306	Reinterview Study 2020	Form and Instruction	Unchanged	Reinterview Study 2020
214306	Reinterview Study 2020	Form and Instruction	Unchanged
214305	Retrieve Medical Records 2020	Instruction	Unchanged
214300	Ambulatory Unit Induction Interview 2020	Form and Instruction	Unchanged	Ambulatory Unit Induction Questionnaire 2020
214300	Ambulatory Unit Induction Interview 2020	Form and Instruction	Unchanged
214297	Hospital Induction Interview 2020	Form and Instruction	Unchanged	Hospital induction questionnaire 2020
214297	Hospital Induction Interview 2020	Form and Instruction	Unchanged

ICR Details

OMB Control No: 0920-0278	ICR Reference No: 202201-0920-017
Status: Historical Active	Previous ICR Reference No: 202004-0920-006
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-22BT
Title: National Hospital Ambulatory Medical Care Survey
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: 03/11/2022
Retrieve Notice of Action (NOA)	Date Received in OIRA: 01/26/2022
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	09/30/2023	09/30/2023
Responses	56,507	0	56,507
Time Burden (Hours)	1,500	0	1,500
Cost Burden (Dollars)	70,597	0	70,597

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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. This submission requests OMB approval for the revision of the 2022 NHAMCS Hospital and Ambulatory Unit Induction Interview Questionnaires to include 18 new questions and the removal of eight questions to improve the quality of data collected on hospital emergency service areas; to improve the recruitment process of sampled hospitals; to confirm the status of medical records obtained from a merged or separated hospital respondent; to assess the impact of telehealth utilization in the ED during the COVID-19 pandemic, and to evaluate hospitals’ COVID-19 vaccination efforts for the 2022 data collection, and subsequent data years if such data are still deemed relevant to be collected.

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

Citations for New Statutory Requirements: None

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

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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

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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 2020	none	Ambulatory Unit Induction Questionnaire 2020
Ambulatory Unit Induction Interview 2022	0920-22BT	Attachment E - Ambulatory Unit Induction Questionnaire (2022)
Hospital Induction Interview 2020	none	Hospital induction questionnaire 2020
Hospital Induction Interview 2022	0920-22BT, NA	2021 NHAMCS Hospital Induction Questionnaire ,   Attachment D - Hospital Induction Questionnaire (2022)
Reinterview Study 2020	none	Reinterview Study 2020
Reinterview Study 2021	none	Reinterview Study 2021
Retrieve Medical Records 2020
Retrieve Medical Records 2021

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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	56,507	0	0	0	0
Annual Time Burden (Hours)	1,500	1,500	0	0	0	0
Annual Cost Burden (Dollars)	70,597	70,597	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:

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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

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Common Form ICR:  No

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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: 01/26/2022

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