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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Testing of: NHAMCS, NAMCS, 2010 "Itsinourhands" web site, 2010 CFU, 2010 ACS, and 2010 Mailout Materials
Agency IC Tracking Number:
IC Status:
New
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
NHAMCS-101
National Hospital AmbulatoryMedical Care Survey -- 2009 Panel
nhamcs101_071508.pdf
No
Paper Only
Form
NHAMCS-101(C)
National Hospital Ambulatory Medical Care Survey -- 2009 Panel Control Card
nhamcs101c_07012008.pdf
No
Paper Only
Form
NMACS-101(U)
Ambulatory Unit Record, National Hospital Ambulatory Medical Care Survey -- 2009 Panel
nhamcs101u_07012008.pdf
No
Paper Only
Form
NMACS-100(ASC)
National Hospital Ambulatory Medical Care Survey -- 2009 Ambulatory Surgery Center Patient Record Folio
nhamcs100asc_071508.pdf
No
Paper Only
Other-NHMACS Draft ASC Respondent Debriefing
NHAMCS2enc2.doc
No
Paper Only
Other-Lipoprotien Cholesterol Values Worksheet
NAMCS2enc1.doc
No
Paper Only
Other-Debriefing Questionnaire
NAMCS2enc2.doc
No
Paper Only
Other-Letter of Explanation
NAMCS2enc3.doc
No
Paper Only
Other-User Interview Discussion Outline
itsinourhands2010website user researchenc.doc
No
Paper Only
Form
DD-1302 (CFU)
Coverage Followup Questionnaire
2010CFU-CPEXenc1.pdf
No
Paper Only
Other-Experimental Questions for Undercount Situation
2010CFU-CPEXenc2.doc
No
Paper Only
Other-Mailing 1
acs2010materialsenc1.pdf
No
Paper Only
Other-Mailing 2
acs2010materialsenc2.pdf
No
Paper Only
Other-Mailing 3
acs2010materialsenc3.pdf
No
Paper Only
Other-Mailing 4
acs2010materialsenc4.pdf
No
Paper Only
Other-Mailing 5
acs2010materialsenc5.pdf
No
Paper Only
Other-Mailing 6
acs2010materialsenc6.pdf
No
Paper Only
Other-Mailing 7
acs2010materialsenc7.pdf
No
Paper Only
Other-Mailing 8
acs2010materialsenc8.pdf
No
Paper Only
Other-envelope
Census 2010 Mailout Materialsenc1.pdf
No
Paper Only
Other-envelope
Census 2010 Mailout Materialsenc2.pdf
No
Paper Only
Other-letter
Census 2010 Mailout Materialsenc3.pdf
No
Paper Only
Other-letter
Census 2010 Mailout Materialsenc4.pdf
No
Paper Only
Other-envelope
Census 2010 Mailout Materialsenc5.pdf
No
Paper Only
Other-envelope
Census 2010 Mailout Materialsenc6.pdf
No
Paper Only
Other-postcard
Census 2010 Mailout Materialsenc7.pdf
No
Paper Only
Other-postcard
Census 2010 Mailout Materialsenc8.pdf
No
Paper Only
Other-postcard
Census 2010 Mailout Materialsenc9.pdf
No
Paper Only
Other-postcard
Census 2010 Mailout Materialsenc10.pdf
No
Paper Only
Other-letter
Census 2010 Mailout Materialsenc11.pdf
No
Paper Only
Other-letter
Census 2010 Mailout Materialsenc12.pdf
No
Paper Only
Other-letter
Census 2010 Mailout Materialsenc13.pdf
No
Paper Only
Other-letter
Census 2010 Mailout Materialsenc14.pdf
No
Paper Only
Form
DY-1(X)
Census 2010
Census 2010 Mailout Materialsenc15.pdf
No
Paper Only
Other-envelope
Census 2010 Mailout Materialsenc16.pdf
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
General Government
Subfunction:
Central Records & Statistical Mgt
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
130
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
130
0
0
0
0
0
Annual IC Time Burden (Hours)
150
0
0
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
NHMACS Testing Plan
NHAMCS2rev.wpd
10/09/2008
NAMCS Testing Plan
NAMCS2.wpd
10/07/2008
Itsinourhands 2010 User Website Testing Plan
itsinourhands2010website user researchrev2.doc
10/07/2008
2010 CFU Testing Plan
2010CFU-CPEX.wpd
10/07/2008
ACS 2010 Mailout Materials Testing Plan
acs2010materials.doc
10/09/2008
Census 2010 Mailout Materials Testing Plan
Census 2010 Mailout Materials.wpd
10/09/2008
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.