National Ambulatory Medical Care Survey (NAMCS)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920-0234 Set-up Fee Questionnaire (2023-2025)	Form and Instruction	New	Repair queued
Form 0920-0234 Prepare and transmit EHR for Visit Data (quarterly) (2023-2025)	Form and Instruction	New	Available
Form 0920-0234 Prepare and transmit EHR for Visit Data (quarterly) (2022)	Form and Instruction	New	Repair queued
Form 0920-0234 Contact Tracing	Form and Instruction	New	Available
Form 0920-0234 Advance Practice ACPI	Form and Instruction	New	Repair queued
Form 0920-0234 Contact Tracing	Form and Instruction	New	Repair queued
Form 0920-0234 ACPI	Form and Instruction	New	Repair queued
Form 0920-0234 Set-up Fee Questionnaire	Form and Instruction	New	Repair queued
Form 0920-0234 Reinterview Study (2021-2023)	Form and Instruction	Removed	Available
Form 0920-0234 Prepare and transmit EHR for Visit Data (quarterly) (2022)	Form and Instruction	Modified	Repair queued
Form 0920-0234 HC Facility Interview 2022	Form and Instruction	Modified	Repair queued
Form 0920-0234 PFI (2023- 2025)	Form and Instruction	Modified	Repair queued
Form 0920-0234 Pulling, re-filing medical record forms (FR abstracts) (2021-2023)	Form and Instruction	Removed	Repair queued
Form 0920-0234 Physician Induction Interview (2021-2023)	Form and Instruction	Removed	Repair queued
Form 0920-0234 Reinterview Study - Traditional Physician and CHC Staff	Form	Removed	Repair queued
Form 0920-0234 HC Facility Interview (2023-2025)	Form and Instruction	Modified	Repair queued
Form 0920-2034 Pulling and Refiling Medical Record Forms EHR Onboarding) (2021-2023)	Form and Instruction	Removed	Repair queued
Form 0920-0234 Pulling, re-filing medical record forms (FR abstracts) (2020)	Form	Removed	Repair queued
Form 0920-0234 Provider Induction Interview (2020)	Form and Instruction	Removed	Repair queued
Form 0920-0234 Physician Induction Interview (2020)	Form and Instruction	Removed	Missing upstream
Attachment P_2021 NAMCS Endorsing Organizations.docx	Supplementary Document	Uploaded 2022-10-21	Repair queued
Attachment N2_NAMCS Provider Introductory Letters.docx	Supplementary Document	Uploaded 2022-10-21	Available
Attachment N1_NAMCS HC Outreach Letters.pdf	Supplementary Document	Uploaded 2022-10-21	Repair queued
Attachment M_NAMCS ERB Approval Letter.pdf	Supplementary Document	Uploaded 2022-10-21	Repair queued
Attachment L_Consultants for NAMCS_2.0.docx	Supplementary Document	Uploaded 2022-10-21	Repair queued
Attachment K_BSC NAMCS Workgroup Meeting Summary.docx	Supplementary Document	Uploaded 2022-10-21	Missing upstream
Attachment H_EHR Implementation guide templates.pdf	Supplementary Document	Uploaded 2022-10-21	Repair queued
Attachment G_EHR Implementation guide.pdf	Supplementary Document	Uploaded 2022-10-21	Repair queued
Attachment F_Electronic Health Record (EHR) Variable List.xlsx	Supplementary Document	Uploaded 2022-10-21	Available
Attachment A_Authorizing Legislative.pdf	Supplementary Document	Uploaded 2022-10-21	Repair queued
Att M3-2022&2023 NAMCS Advance Letters_07.08.2021.pdf	Supplementary Document	Uploaded 2021-07-08	Repair queued
Att N- 2020 NAMCS Endorsing Organizations.pdf	Supplementary Document	Uploaded 2021-05-28	Repair queued
Att M2- 2021 NAMCS Advance Letters.pdf	Supplementary Document	Uploaded 2021-05-28	Repair queued
Att M1- 2020 NAMCS Advance Letters.pdf	Supplementary Document	Uploaded 2021-05-28	Repair queued
Att L- 2020 NAMCS ERB Continuation Letter.pdf	Supplementary Document	Uploaded 2021-05-28	Repair queued
Att K- 2021-2023 Consultants.docx	Supplementary Document	Uploaded 2021-05-28	Available
Att J- EHR Implementation Guide Templates.pdf	Supplementary Document	Uploaded 2021-05-28	Repair queued
Att I- EHR Implementation Guide.pdf	Supplementary Document	Uploaded 2021-05-28	Repair queued
Att H- EHR Variable List.xlsx	Supplementary Document	Uploaded 2021-05-28	Repair queued
Att G2- 2021 NAMCS PRF.pdf	Supplementary Document	Uploaded 2021-05-28	Repair queued
Att G1- 2020 NAMCS PRF.pdf	Supplementary Document	Uploaded 2021-05-28	Repair queued
Att D- 2020 BSC NAMCS Workgroup Meeting Summary.docx	Supplementary Document	Uploaded 2021-05-28	Repair queued
Att C3- 2020 Draft FR Incentive Script.docx	Supplementary Document	Uploaded 2021-05-28	Repair queued
Att B- 60 Day Notice.docx	Supplementary Document	Uploaded 2021-05-28	Repair queued
Att A- Authorizing Legislation 012519.pdf	Supplementary Document	Uploaded 2021-05-28	Repair queued
NAMCS SSB_2023-2025_09082022.docx	Supporting Statement B	Uploaded 2022-10-21	Repair queued
NAMCS SSA_2023-2025_09082022.docx	Supporting Statement A	Uploaded 2022-10-21	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
256557	Set-up Fee Questionnaire (2023-2025)	Form and Instruction	New
256556	Prepare and transmit EHR for Visit Data (quarterly) (2023-2025)	Form and Instruction	New
256555	Prepare and transmit EHR for Visit Data (quarterly) (2022)	Form and Instruction	New
256554	Contact Tracing	Form and Instruction	New
256553	Advance Practice ACPI	Form and Instruction	New
256552	Contact Tracing	Form and Instruction	New
256551	ACPI	Form and Instruction	New
256550	Set-up Fee Questionnaire	Form and Instruction	New
247679	Reinterview Study (2021-2023)	Form and Instruction	Removed
247678	Prepare and transmit EHR for Visit Data (quarterly) (2022)	Form and Instruction	Modified
247676	HC Facility Interview 2022	Form and Instruction	Modified
247675	PFI (2023- 2025)	Form and Instruction	Modified
247672	Pulling, re-filing medical record forms (FR abstracts) (2021-2023)	Form and Instruction	Removed
247670	Physician Induction Interview (2021-2023)	Form and Instruction	Removed
235134	Reinterview Study - Traditional Physician and CHC Staff	Form	Removed
220059	HC Facility Interview (2023-2025)	Form and Instruction	Modified
213885	Pulling and Refiling Medical Record Forms EHR Onboarding) (2021-2023)	Form and Instruction	Removed
213884	Pulling, re-filing medical record forms (FR abstracts) (2020)	Form	Removed
213883	Provider Induction Interview (2020)	Form and Instruction	Removed
213881	Physician Induction Interview (2020)	Form and Instruction	Removed

ICR Details

OMB Control No: 0920-0234	ICR Reference No: 202210-0920-012
Status: Received in OIRA	Previous ICR Reference No: 202105-0920-006
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-0234
Title: National Ambulatory Medical Care Survey (NAMCS)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  Yes
Type of Review Request: Regular	Date Submitted to OIRA: 10/21/2022

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	07/31/2024
Responses	83,206	69,872
Time Burden (Hours)	37,744	6,819
Cost Burden (Dollars)	0	0

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Abstract: The purpose of this request is for NAMCS to meet the needs and demands for statistical information about the provision of ambulatory medical care services in the United States; and fulfill NCHS’ mission to collect, analyze, and disseminate timely, relevant, and accurate health data and statistics. Additional justifications for conducting NAMCS include the need for more complete data to study: (1) the performance of the U.S. health care system, (2) care for the rapidly aging population, (3) changes in services such as health insurance coverage, (4) the introduction of new medical technologies, (5) the use of HCs in the health care community, and (6) the use of EHRs.

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Authorizing Statute(s): US Code: 42 USC 242K Name of Law: Public Health Service Act
   PL: Pub.L. 111 - 5 1512 Name of Law: American Recovery and Reinvestment Act of 2009
  

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:
	87 FR 15429	03/18/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 59427	09/30/2022
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 12

table that charts list of burden

IC Title	Form No.	Form Name
ACPI	0920-0234	ACPI
Advance Practice ACPI	0920-0234	Advanced Practice ACPI
Contact Tracing	0920-0234	Tracing Questionnaire
Contact Tracing	0920-0234	Tracing Questionnaire
HC Facility Interview 2022	0920-0234	Health Center (HC) Facility Interview
HC Facility Interview (2023-2025)	0920-0234	HC Facility Interview questionnaire
PFI (2023- 2025)	0920-0234	PFI (2023-2025)
Physician Induction Interview (2020)	0920-0234	Att P2- 2021 Census Reinterview Instrument
Physician Induction Interview (2021-2023)	0920-0234	Physician Induction Interview (2021-2023)
Prepare and transmit EHR for Visit Data (quarterly) (2022)	0920-0234, 0920-0234	Attachment O1_NAMCS EHR Record Pulling Burden ,   Attachment O2_NAMCS EHR Record Pulling Burden
Prepare and transmit EHR for Visit Data (quarterly) (2022)	0920-0234	Attachment O1_NAMCS EHR Record Pulling Burden
Prepare and transmit EHR for Visit Data (quarterly) (2023-2025)	0920-0234	Attachment O1_NAMCS EHR Record Pulling Burden
Provider Induction Interview (2020)	0920-0234	HC Facility Induction Interview (2020)
Pulling and Refiling Medical Record Forms EHR Onboarding) (2021-2023)	0920-2034	EHR Pulling Records Burden
Pulling, re-filing medical record forms (FR abstracts) (2020)	0920-0234, 0920-0234	Att R- 2021 EHR Pulling Records Burden ,   PRF Burden Abstract
Pulling, re-filing medical record forms (FR abstracts) (2021-2023)	0920-0234	Att C2- 2021 NAMCS-1 Traditional Physician
Reinterview Study (2021-2023)	0920-0234	Reinterview Study (2021-2023)
Reinterview Study - Traditional Physician and CHC Staff	0920-0234	2020 Reinterview Instrument
Set-up Fee Questionnaire	0920-0234	Attachment J_Set-up Fee Questionnaire
Set-up Fee Questionnaire (2023-2025)	0920-0234	Attachment J_Set-up Fee Questionnaire

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ICR Summary of Burden

table that charts list of burden

	Total Request	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	83,206	69,872	0	1,370	11,964	0
Annual Time Burden (Hours)	37,744	6,819	0	28,708	2,217	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: A total burden of 37,744 hours is requested for NAMCS. This is an increase of 30,925 burden hours due to program changes.

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Annual Cost to Federal Government: $8,747,341

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

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Common Form ICR:  Yes

Description/Changes for Common Form Usage:  Currently, there are 6,819 burden hours in the OMB inventory. A total burden of 37,744 hours is requested for NAMCS. This is an increase of 30,925 burden hours due to program changes. There is an increase of 19,404 burden hours because of the revision of the Provider Interview Component (redesign of the interview questionnaire and additions to the sample and scope). There is an increase of 772 burden hours because of changes to the HC Component (new Set-Up Fee Questionnaire and additions to the sample). Lastly, there is an increase of 10,750 attributed to the Provider Electronic Component because of the revision sample and submission method.

Approved RCFs using this ICR

table that charts list of RCF

Agency/Sub Agency	RCF ID	RCF Title	RCF Status	IC Title

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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: 10/21/2022

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