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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
QDRL testing on NAMCS physician follow-up, NHIS Complementary and Alternative Medicine, and Spanish version of HIV behavioral surveillance
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
none
Physican Workflow EHR no Adoption Survey
EMR Attach 1b.docx
Yes
Yes
Fillable Fileable
Form
none
Physican Workflow EHR some Adoption Survey
EMR Attach 1a.docx
Yes
Yes
Fillable Fileable
Form
none
Child Component of CAMS
NHIS CAM Attach 1.docx
Yes
Yes
Fillable Fileable
Form
none
NHBS - Spanish version for MSM
Spanish NHBS Attachment 1abc.docx
Yes
Yes
Fillable Fileable
Form
none
NHBS - Spanish screener
Spanish NHBS Attachment 3abc.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
Health and Demographic Surveys Conducted in Probability Samples of the US Population
FR Citation:
49 FR 37693
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)
160
0
0
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Physican Workflow EHR Adoption Survey - 10 day letter
QDRL EMR letter-0112 2011.doc
01/19/2011
Physician Workflow and EHR Survey - advance letters
EMR Attach 2a&b-0112 2011.docx
01/19/2011
NHIS Complementary and Alternative Medicine Supplement - 10 day letter
NHIS CAM 2012 10-day letter.doc
01/19/2011
CAMS - advertisement/flyer
NHIS CAM Attach 2.docx
01/19/2011
NHBS Spanish version - 10 day letter
Spanish NHBS QDRL OMB-10-day letter fnl.doc
01/19/2011
NHBS - Spanish flyer
Spanish NHBS Attachment 2abc.docx
01/19/2011
Letter for combined generic ICs
QDRL-2011 OMB-10-day combo letter 011211.doc
01/19/2011
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.