Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Electronic Medical Record/Electronic Health Record Mail Survey Form Removed 0 0 0 Form unnumbered EMR/EHR Mail Survey form
Lab Values Pretest Induction form Removed 0 0 0 Form unnumbered Lab Values Pretest Induction form
NAMCS EMR/EHR Mail Survey (Line 6) Modified 5604 1868 0 Form and Instruction 6 NAMCS EMR/EHR Mail Survey (Line 6)
NAMCS-1 Physician Induction Interview (Line 1) Modified 3657 1707 0 Form and Instruction 1 NAMCS-1 Physician Induction Interview (Line 1)
NAMCS-201 Community Health Center Induction Interview (Line 2) Modified 104 35 0 Form and Instruction 2 NAMCS-201 Community Health Center Induction Interview (Line 2)
NAMCS-30 Patient Record form (Line 3) Modified 22140 3321 0 Form and Instruction 3 NAMCS-30 Patient Record form (Line 3)
NAMCS-CCS Cervical Cancer Screening Supplement (Line 5) Modified 464 116 0 Form 5 NAMCS-CCS Cervical Cancer Screening Supplement (Line 5)
Pulling and re-filing Patient Record form (Line 4) Modified 19500 325 0 Form 4 Pulling and re-filing Patient Record form (Line 4)
Total burden requested under this ICR: 51469 7372 0  
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