National Ambulatory Medical Care Survey

OMB Control No: 0920-0234	ICR Reference No: 201309-0920-004
Status: Historical Active	Previous ICR Reference No: 201211-0920-001
Agency/Subagency: HHS/CDC	Agency Tracking No: 20471
Title: National 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: 11/04/2013
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/10/2013
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2014	12/31/2014	12/31/2014
Responses	553,650	0	571,530
Time Burden (Hours)	47,943	0	50,923
Cost Burden (Dollars)	0	0	0

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Abstract: This request is for a nonsubstantive change to modify selected sections of the 2012-2014 National Ambulatory Medical Care Survey to colelct new and/or updated information. Minor changes have been made to two survey insturments, and one module (the lookback) was removed.

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Authorizing Statute(s): US Code: 42 USC 242K Name of Law: Public Health Service Act    PL: Pub.L. 111 - 5 1512 Name of Law: American Recovery and Reinvestment Act of 2009

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: 10

IC Title Form No. Form Name NAMCS-1 Physician Induction Interview (Line 1) none NAMCS-1 Induction Interview NAMCS-201 Community Health Center Induction Interview (Line 2) none Att K - Community Health Center Induction Interview NAMCS-30 Patient Record form (Line 3) none Patient Record Form Pulling and re-filing Patient Record form (Line 4) 2012 Asthma Supplement (line 6) none Att B - Asthma Supplement National Electronic Health Records Survey (line 7) None National Electronic Health Records Survey 2013 Physician Workflow Survey (line 8) None, None E. Physician Workflow Survey Year 2013 (EHR adopters) ,   F. Physician Workflow Survey Year 2013 (EHR nonadopters) 2012 CPT Pretest NAMCS-1 (line 9) none Att Z - NAMCS 2011 Panel CPT Code Pretest 2012 Pretest NAMCS Patient Record Form (line 10) none Att BB - NAMCS 2012 - Patient Record Form CPT Code Pretest Re-abstraction Study Lookback Module (Line 5) None National Ambulatory Medical Care Survey 2013 Look Back Module

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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	553,650	571,530	0	-17,880	0	0
Annual Time Burden (Hours)	47,943	50,923	0	-2,980	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: One module (lookback) was removed.

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Annual Cost to Federal Government: $11,399,149

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]? 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: Shari Steinberg 404 639-4942 [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: 09/10/2013

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