Information Collection Request

National Hospital Care Survey

ICR 201302-0920-001 · OMB 0920-0212 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Initial Hospital Intake Questionnaire Form Modified Available
Annual FSASC Interview Form New Repair queued
Prepare and transmit UB-04 for Inpatient and Ambulatory Form Modified Repair queued
Ambulatory Unit Induction Form Modified Repair queued
Annual Ambulatory Hospital Interview Form Modified Available
Annual Inpatient Hospital Interview Form Modified Repair queued
Recruitment Survey Presentation Form Modified Available
NHCS 2013 - 2015 Supporting Statement Part B Final 0 4 12 13.docx Supporting Statement B Uploaded 2013-04-15 Available
Attachment U- NHCS FAQ Brochure .pdf Supplementary Document Uploaded 2013-01-31 Available
Attachment T - AS Patient Record Form.docx Supplementary Document Uploaded 2013-01-31 Available
Attachment S - OPD Patient Record form.docx Supplementary Document Uploaded 2013-01-31 Repair queued
Attachment R - ED Patient Record form.docx Supplementary Document Uploaded 2013-04-15 Repair queued
Attachment H- ERB Approval Notice for NHCS .pdf Supplementary Document Uploaded 2013-01-30 Available
Attachment G- Westat Data Security Plan .pdf Supplementary Document Uploaded 2013-01-30 Available
Attachment F - Hospital Ambulatory Data Collection Flow Chart.docx Supplementary Document Uploaded 2013-04-15 Repair queued
Attachment E- Intro Letter to FSASCs.docx Supplementary Document Uploaded 2013-01-30 Available
Attachment D - Ambulatory Intro Letter to Hospitals EDs OPDs ASLs.docx Supplementary Document Uploaded 2013-01-30 Repair queued
Attachment C- Intro Letter to Hospitals.docx Supplementary Document Uploaded 2013-01-30 Available
Attachment B- Federal Register Notice for NHCS.pdf Supplementary Document Uploaded 2013-01-30 Repair queued
Attachment A - Legislative Authority to Collect Data on Hospital Utilization.rtf Supplementary Document Uploaded 2013-01-30 Repair queued
Attachment Q- List of UB04 Data Elements.docx Supplementary Document Uploaded 2013-01-31 Repair queued
Attachment Q- List of UB04 Data Elements.docx Supplementary Document Uploaded 2013-01-31 Repair queued
NHCS 2013 - 2015 Supporting Statement Part A__Revised 032713_LM.DOCX Supporting Statement A Uploaded 2013-04-15 Available
ICR Details
0920-0212 201302-0920-001
Historical Active 201104-0920-011
HHS/CDC 18672
National Hospital Care Survey
Revision of a currently approved collection   No
Regular
Approved without change 04/15/2013
Retrieve Notice of Action (NOA) 02/01/2013
NCHS will communicate regularly with OMB about outcome of its preliminary work regarding combining NHAMCS with the NHCS, and the expected timing of combining these ICRs as well as its progress on developing the frame for the free standing ambulatory care facilities.
  Inventory as of this Action Requested Previously Approved
04/30/2016 36 Months From Approved 04/30/2014
131,516 0 2,711
7,224 0 3,520
0 0 0

NCHS requests approval to continue the NHCS and to begin to integrate the NHAMCS into NHCS as part of a broader strategy to improve efficiency by minimizing redundancy in data collection, broadening capability to collect more relevant data on transitions in care, and identifying opportunities to exploit administrative and electronic clinical data systems. NHCS will electronically collect administrative claims data, but as hospitals adopt EHRs, it will be poised to accept electronic files. In 2013 NHAMCS will operate in tandem with the ambulatory component of NHCS so data from the two surveys can be compared.

US Code: 42 USC 242k Name of Law: Public Health Service Act
  
None

Not associated with rulemaking

  77 FR 61411 10/09/2012
78 FR 6327 01/30/2013
No

  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 131,516 2,711 0 128,805 0 0
Annual Time Burden (Hours) 7,224 3,520 0 3,704 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
Yes
Miscellaneous Actions
The increase in burden is due to hospital outpatient and emergency departments and Freestanding Ambulatory Surgery facilities that will be included in the NHCS.

$9,173,000
Yes Part B of Supporting Statement
No
Yes
No
No
Uncollected
Tony Richardson 404 639-4965 [email protected]

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
02/01/2013