Contact Tracing

National Ambulatory Medical Care Survey (NAMCS)

Documents and Forms

Document Name Document Type
Form 0920-0234 Contact Tracing Form and Instruction
0920-0234 Tracing Questionnaire Attachment D_Tracing Questionnaire.docx Form and Instruction
0920-0234 Tracing Questionnaire Attachment D_Tracing Questionnaire.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Contact Tracing	Agency IC Tracking Number:	0920-0234

Is this a Common Form? Yes		IC Status: New

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	Tracing Questionnaire	Attachment D_Tracing Questionnaire.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 21,667	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 %

	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	21,667	10,000	11,667
Annual IC Time Burden (Hours)	3,611	1,666	1,945
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.