Prepare and transmit EHR for Visit Data (quarterly) (2022)

National Ambulatory Medical Care Survey (NAMCS)

Documents and Forms

Document Name Document Type
Form 0920-0234 Prepare and transmit EHR for Visit Data (quarterly) (2022) Form and Instruction
0920-0234 Attachment O1_NAMCS EHR Record Pulling Burden Attachment O1_NAMCS EHR Record Pulling Burden.docx Form and Instruction
0920-0234 Attachment O1_NAMCS EHR Record Pulling Burden Attachment O1_NAMCS EHR Record Pulling Burden.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Prepare and transmit EHR for Visit Data (quarterly) (2022)	Agency IC Tracking Number:	0920-0234

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-0234	Attachment O1_NAMCS EHR Record Pulling Burden	Attachment O1_NAMCS EHR Record Pulling Burden.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 33	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: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	132	-236	368
Annual IC Time Burden (Hours)	132	-236	368
Annual IC Cost Burden (Dollars)	0	0	0

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.