Information Collection

(ACPI) Providers and their Proxies (Survey year: 2026)

IC 247675 under ICR 202412-0920-002 · OMB 0920-0234.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0234 (ACPI) Providers and their Proxies (Survey year: 2026)	Form and Instruction
Form 0920-0234 NAMCS Provider Facility Interview (PFI) (ACPI) Providers and their Proxies (Survey year: 2026)	Form and Instruction
Form 0920-0234 NAMCS Ambulatory Care Provider Interview (ACPI) Providers and their Proxies_10JAN2025 (ACPI) Providers and their Proxies (Survey year: 2026)	Form and Instruction
0920-0234 NAMCS Provider Facility Interview (PFI) Attachment L_NAMCS Provider Facility Interview.docx	Form and Instruction
0920-0234 NAMCS Provider Facility Interview (PFI) Attachment L_NAMCS Provider Facility Interview.docx	Form and Instruction
0920-0234 NAMCS Ambulatory Care Provider Interview (ACPI) Provider Attachment D_ACPI_Provider.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? Yes

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-0234				Yes	Yes	Fillable Fileable
Form and Instruction	0920-0234			N/A	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,333

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 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	3,333	333	3,000
Annual IC Time Burden (Hours)	833	-1,417	2,250
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.

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