Information Collection Request

National Ambulatory Medical Care Survey (NAMCS)

ICR 202412-0920-002 · OMB 0920-0234 · Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 0920-0234 Set-up Fee Questionnaire (2024) Form and Instruction Modified Available
Form 0920-0234 Set-up Fee Questionnaire (H/C staff) (Survey year: 2024) Form and Instruction Modified Repair queued
Form 0920-0234 EHR Implementation Guide Form and Instruction Modified Available
Form 0920-0234 EHR Implementation Guide Templates Form and Instruction Modified Available
Form 0920-0234 EHR for Visit Data (quarterly) (Survey yr: 2025-2027)_HC staff Form and Instruction Modified Repair queued
Form 0920-0234 Attachment O2_NAMCS EHR Record Pulling Burden Form and Instruction Modified Available
Form 0920-0234 EHR Implementation Guide Templates Form and Instruction Modified Available
Form 0920-0234 EHR for Visit Data (quarterly) (Survey year: 2025-2027)_ACP staff Form and Instruction Modified Repair queued
Form 0920-0234 NAMCS Tracing Questionnaire Form and Instruction Modified Available
Form 0920-0234 NAMCS Tracing Questionnaire (Survey year: 2026) Form and Instruction Modified Repair queued
Form 0920-0234 NAMCS Provider Facility Interview (PFI)_10JAN2025 Form and Instruction Modified Available
Form 0920-0234 NAMCS Provider Facility Interview (PFI) Form and Instruction Modified Available
Form 0920-0234 NAMCS Provider Facility Interview (PFI) (Survey year: 2025 & 2027) Form and Instruction Modified Available
Form 0920-0234 NAMCS Tracing Questionnaire (Survey year 2025 & 2027) Form and Instruction Modified Available
Form 0920-0234 NAMCS Tracing Questionnaire (Survey year: 2025 & 2027) _ Advanced Form and Instruction Modified Missing upstream
Form 0920-0234 NAMCS Ambulatory Care Provider Interview (ACPI) Advanced Practice Provider Interview_10JAN2025 Form and Instruction Modified Available
Form 0920-0234 NAMCS Ambulatory Care Provider Interview (ACPI) Advanced Practice Provider and their Proxies Form and Instruction Modified Available
Form 0920-0234 (ACPI) Advanced Practice Provider and their Proxies (Survey year: 2025 & 2027) Form and Instruction Modified Missing upstream
Form 0920-0234 Set-up Fee Questionnaire Form and Instruction Modified Available
Form 0920-0234 Set-up Fee Questionnaire (H/C staff) (Survey year: 2025-2027) Form and Instruction Modified Repair queued
Form 0920-0234 HL7 CDA® R2 Implementation Guide: National Health Care Surveys Release 1, Form and Instruction Modified Available
Form 0920-0234 National Health Care Surveys Release 1 Form and Instruction Modified Available
Form 0920-0234 NAMCS Electronic Health Record (EHR): Pulling and Sending Records Form and Instruction Modified Available
Form 0920-0234 EHR for Visit Data (quarterly) (2024) Form and Instruction Modified Available
Form 0920-0234 2025-2027 Health Center Component Facility Interview Form and Instruction Modified Available
Form 0920-0234 Health Center Component Facility Interview (Survey year: 2025 & 2027) Form and Instruction Modified Repair queued
Form 0920-0234 NAMCS Ambulatory Care Provider Interview (ACPI) Providers and their Proxies_10JAN2025 Form and Instruction Modified Available
Form 0920-0234 NAMCS Provider Facility Interview (PFI) Form and Instruction Modified Available
Form 0920-0234 (ACPI) Providers and their Proxies (Survey year: 2026) Form and Instruction Modified Repair queued
Form 0920-0234 2024 Health Center Component Facility Interview Form and Instruction Modified Available
Form 0920-0234 Health Center Component Facility Interview (Survey year: 2024) Form and Instruction Modified Repair queued
Attachment E_ACPI_Advanced Practice Provider_clean_03142025.docx Supplementary Document Uploaded 2025-03-18 Repair queued
Attachment D_ACPI_Provider_clean_03142025.docx Supplementary Document Uploaded 2025-03-18 Repair queued
Attachment N3_NAMCS PFI Introductory Letters.pdf Supplementary Document Uploaded 2024-12-20 Available
Attachment N3_NAMCS PFI Introductory Letters.pdf Supplementary Document Uploaded 2024-12-20 Repair queued
Attachment Q_System of Records Notice.pdf Supplementary Document Uploaded 2024-12-20 Repair queued
Attachment Q_System of Records Notice.pdf Supplementary Document Uploaded 2024-12-20 Repair queued
Attachment P_2023 NAMCS Endorsing Organizations.docx Supplementary Document Uploaded 2024-12-20 Repair queued
Attachment P_2023 NAMCS Endorsing Organizations.docx Supplementary Document Uploaded 2024-12-20 Repair queued
Attachment N2_NAMCS Provider Survey Component Introductory Letters.pdf Supplementary Document Uploaded 2024-12-20 Repair queued
Attachment N2_NAMCS Provider Survey Component Introductory Letters.pdf Supplementary Document Uploaded 2024-12-20 Repair queued
Attachment N1_NAMCS Health Center Introductory Letters.pdf Supplementary Document Uploaded 2024-12-20 Repair queued
Attachment N1_NAMCS Health Center Introductory Letters.pdf Supplementary Document Uploaded 2024-12-20 Repair queued
Attachment M_NAMCS ERB Approval Letter.pdf Supplementary Document Uploaded 2024-12-20 Repair queued
Attachment M_NAMCS ERB Approval Letter.pdf Supplementary Document Uploaded 2024-12-20 Missing upstream
Attachment J_Consultants for NAMCS.docx Supplementary Document Uploaded 2024-12-20 Repair queued
Attachment J_Consultants for NAMCS.docx Supplementary Document Uploaded 2024-12-20 Missing upstream
Attachment G_Electronic Health Record (EHR) Variable List.xlsx Supplementary Document Uploaded 2025-01-10 Repair queued
Attachment G_Electronic Health Record (EHR) Variable List.xlsx Supplementary Document Uploaded 2024-12-20 Repair queued
Attachment B_60-day Federal Register Notice.pdf Supplementary Document Uploaded 2024-12-20 Repair queued
Attachment B_60-day Federal Register Notice.pdf Supplementary Document Uploaded 2024-12-20 Repair queued
Attachment A_Authorizing Legislative.pdf Supplementary Document Uploaded 2024-12-20 Repair queued
Attachment A_Authorizing Legislative.pdf Supplementary Document Uploaded 2024-12-20 Repair queued
NAMCS SSB_2025-2027_clean_03172025.docx Supporting Statement B Uploaded 2025-03-18 Repair queued
NAMCS SSB_2025-2027_12052024_CLEAN.docx Supporting Statement B Uploaded 2024-12-20 Repair queued
NAMCS SSA_2025-2027_clean_03142025.docx Supporting Statement A Uploaded 2025-03-18 Repair queued
NAMCS SSA_2025-2027_12052024_CLEAN.docx Supporting Statement A Uploaded 2024-12-20 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
256557 Set-up Fee Questionnaire (H/C staff) (Survey year: 2024) Form and Instruction ModifiedSet-up Fee Questionnaire (2024)
256557 Set-up Fee Questionnaire (H/C staff) (Survey year: 2024) Form and Instruction Modified
256556 EHR for Visit Data (quarterly) (Survey yr: 2025-2027)_HC staff Form and Instruction ModifiedEHR Implementation Guide
256556 EHR for Visit Data (quarterly) (Survey yr: 2025-2027)_HC staff Form and Instruction ModifiedEHR Implementation Guide Templates
256556 EHR for Visit Data (quarterly) (Survey yr: 2025-2027)_HC staff Form and Instruction Modified
256555 EHR for Visit Data (quarterly) (Survey year: 2025-2027)_ACP staff Form and Instruction ModifiedAttachment O2_NAMCS EHR Record Pulling Burden
256555 EHR for Visit Data (quarterly) (Survey year: 2025-2027)_ACP staff Form and Instruction ModifiedEHR Implementation Guide Templates
256555 EHR for Visit Data (quarterly) (Survey year: 2025-2027)_ACP staff Form and Instruction Modified
256554 NAMCS Tracing Questionnaire (Survey year: 2026) Form and Instruction ModifiedNAMCS Tracing Questionnaire
256554 NAMCS Tracing Questionnaire (Survey year: 2026) Form and Instruction Modified
256553 NAMCS Provider Facility Interview (PFI) (Survey year: 2025 & 2027) Form and Instruction ModifiedNAMCS Provider Facility Interview (PFI)_10JAN2025
256553 NAMCS Provider Facility Interview (PFI) (Survey year: 2025 & 2027) Form and Instruction ModifiedNAMCS Provider Facility Interview (PFI)
256553 NAMCS Provider Facility Interview (PFI) (Survey year: 2025 & 2027) Form and Instruction Modified
256552 NAMCS Tracing Questionnaire (Survey year: 2025 & 2027) _ Advanced Form and Instruction ModifiedNAMCS Tracing Questionnaire (Survey year 2025 & 2027)
256552 NAMCS Tracing Questionnaire (Survey year: 2025 & 2027) _ Advanced Form and Instruction Modified
256551 (ACPI) Advanced Practice Provider and their Proxies (Survey year: 2025 & 2027) Form and Instruction ModifiedNAMCS Ambulatory Care Provider Interview (ACPI) Advanced Practice Provider Interview_10JAN2025
256551 (ACPI) Advanced Practice Provider and their Proxies (Survey year: 2025 & 2027) Form and Instruction ModifiedNAMCS Ambulatory Care Provider Interview (ACPI) Advanced Practice Provider and their Proxies
256551 (ACPI) Advanced Practice Provider and their Proxies (Survey year: 2025 & 2027) Form and Instruction Modified
256550 Set-up Fee Questionnaire (H/C staff) (Survey year: 2025-2027) Form and Instruction ModifiedSet-up Fee Questionnaire
256550 Set-up Fee Questionnaire (H/C staff) (Survey year: 2025-2027) Form and Instruction Modified
247678 EHR for Visit Data (quarterly) (2024) Form and Instruction ModifiedHL7 CDA® R2 Implementation Guide: National Health Care Surveys Release 1,
247678 EHR for Visit Data (quarterly) (2024) Form and Instruction ModifiedNational Health Care Surveys Release 1
247678 EHR for Visit Data (quarterly) (2024) Form and Instruction ModifiedNAMCS Electronic Health Record (EHR): Pulling and Sending Records
247678 EHR for Visit Data (quarterly) (2024) Form and Instruction Modified
247676 Health Center Component Facility Interview (Survey year: 2025 & 2027) Form and Instruction Modified2025-2027 Health Center Component Facility Interview
247676 Health Center Component Facility Interview (Survey year: 2025 & 2027) Form and Instruction Modified
247675 (ACPI) Providers and their Proxies (Survey year: 2026) Form and Instruction ModifiedNAMCS Ambulatory Care Provider Interview (ACPI) Providers and their Proxies_10JAN2025
247675 (ACPI) Providers and their Proxies (Survey year: 2026) Form and Instruction ModifiedNAMCS Provider Facility Interview (PFI)
247675 (ACPI) Providers and their Proxies (Survey year: 2026) Form and Instruction Modified
220059 Health Center Component Facility Interview (Survey year: 2024) Form and Instruction Modified2024 Health Center Component Facility Interview
220059 Health Center Component Facility Interview (Survey year: 2024) Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
03/31/2028 36 Months From Approved 11/30/2025
36,291 0 83,206
19,606 0 37,744
0 0 0





Reginfo record details
12
table that charts list of burden
IC Title Form No. Form Name
(ACPI) Advanced Practice Provider and their Proxies (Survey year: 2025 & 2027) 0920-0234, 0920-0234 ,  
EHR for Visit Data (quarterly) (Survey year: 2025-2027)_ACP staff 0920-0234, 0920-0234 ,  
(ACPI) Providers and their Proxies (Survey year: 2026) 0920-0234, 0920-0234 ,  
EHR for Visit Data (quarterly) (2024) 0920-0234, 0920-0234, 0920-0234 ,   ,  
EHR for Visit Data (quarterly) (Survey yr: 2025-2027)_HC staff 0920-0234, 0920-0234 ,  
Health Center Component Facility Interview (Survey year: 2024) 0920-0234
Health Center Component Facility Interview (Survey year: 2025 & 2027) 0920-0234
NAMCS Provider Facility Interview (PFI) (Survey year: 2025 & 2027) 0920-0234, 0920-0234 ,  
NAMCS Tracing Questionnaire (Survey year: 2025 & 2027) _ Advanced 0920-0234
NAMCS Tracing Questionnaire (Survey year: 2026) 0920-0234
Set-up Fee Questionnaire (H/C staff) (Survey year: 2024) 0920-0234
Set-up Fee Questionnaire (H/C staff) (Survey year: 2025-2027) 0920-0234

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 36,291 83,206 0 -46,915 0 0
Annual Time Burden (Hours) 19,606 37,744 0 -18,138 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  Yes
  The Survey contains fixed and rotational components, which will allow swift updates/additions when quick turnaround is necessary, for example the addition of COVID-19 questions during the 2020 data collection. The decreased sample size for the HC Component and the Provider Survey Component in the current NAMCS OMB package will decrease the requested burden hours.
Reginfo record details
table that charts list of RCF
Agency/Sub Agency RCF ID RCF Title RCF Status IC Title