National Hospital Ambulatory Medical Care Survey

OMB Control No: 0920-0278	ICR Reference No: 201011-0920-002
Status: Historical Active	Previous ICR Reference No: 201007-0920-004
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: National Hospital Ambulatory Medical Care Survey
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/02/2010
Retrieve Notice of Action (NOA)	Date Received in OIRA: 11/02/2010
Terms of Clearance: Cleared on the understanding that NCHS and ONC staff have committed to consult with OMB during the development of the next iteration of the EHR/EMR component for NAMCS/HAMCS.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2012	08/31/2012	08/31/2012
Responses	128,141	0	128,141
Time Burden (Hours)	12,112	0	12,112
Cost Burden (Dollars)	0	0	0

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Abstract: This request is to modify/add selected questions on Electronic medical record usage and delete the cancer supplement starting in 2011 to the ongoing OMB 0920-0278 -National Hospital Ambulatory Medical Care Survey (NHAMCS).

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Authorizing Statute(s): US Code: 42 USC 306 Name of Law: Public Health Service Act

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

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 8

IC Title Form No. Form Name Pulling and re-filing Patient Records Freestanding ASC Induction Form none, none Freestanding Ambulatory Surgery Centers Form ,   Freestanding Ambulatory Surgery Centers Form - 11/29/2010 Ambulatory Unit Record unnumbered, none Att. J. Ambulatory Unit Induction Form ,   Att. J. Ambulatory Unit Induction Form - 11/29/2010 Hospital Induction Form none, none Hospital Induction Form ,   Hospital Induction Form - 11/29/2010 ED Patient Record Form unnumbered Att. M. ED Patient Record Form ASC Patient Record Form unnumbered Att. O. ASC Patient Record Form OPD Patient Record Form none, none OPD Patient Record ,   OPD Patient Record - 11/29/2010 Cervical Cancer Screening Supplement unnumbered Att. T. Cervical Cancer Screening Supplement

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ICR Summary 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	128,141	128,141	0	0	0	0
Annual Time Burden (Hours)	12,112	12,112	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $4,473,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

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)? Yes

Is this ICR related to the Pandemic Response? Uncollected

Agency Contact: Carol Walker 4046394773

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Common Form ICR:  No

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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: 11/02/2010

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