National Hospital Ambulatory Medical Care Survey

OMB Control No: 0920-0278	ICR Reference No: 201203-0920-008
Status: Historical Active	Previous ICR Reference No: 201110-0920-011
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: 04/18/2012
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/26/2012
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2014	12/31/2014	12/31/2014
Responses	112,187	0	111,395
Time Burden (Hours)	10,017	0	9,999
Cost Burden (Dollars)	0	0	0

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Abstract: NCHS requests a modification to allow for reabstraction of some visit data to verify the consistency of data abstraction.

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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? Yes

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Number of Information Collection (IC) in this ICR: 12

IC Title Form No. Form Name Cervical Cancer Screening Supplement unnumbered Att. T. Cervical Cancer Screening Supplement Ambulatory Unit Induction Hospital Induction Form ED Patient Record Form ASC Patient Record Form unnumbered Att. O. ASC Patient Record Form OPD Patient Record Form Pulling and re-filing Patient Records Freestanding ASC Induction Form Pretests none, none, none, none, none, none, none, none, none Hospital Induction Pretest ,   Ambulatory Unit Induction pretest ,   Freestanding Ambulatory Surgery Center Induction ,   Asthma Management Supplement Pretest ,   Outpatient Dept Patient Record Pretest ,   Ambulatory Surgery Center Pretest ,   Emergency Dept Patient Pretest ,   Lookback Module Pretest ,   Pulling & Refiling Records Pretest Hospital Induction (new sample) Reabstraction Telephone Call Medical Record Reabstraction

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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	112,187	111,395	0	792	0	0
Annual Time Burden (Hours)	10,017	9,999	0	18	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: NCHS requests a modification to allow for reabstraction of some visit data to verify the consistency of data abstraction.

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Annual Cost to Federal Government: $6,032,000

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? Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Yes

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: Tony Richardson 404 639-4965 [email protected]

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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: 03/26/2012

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