Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
2011 Pretest Asthma Supplement (line 9) New 100 25 0 Form none 2011 Pretest Asthma Supplement
2011 Pretest NAMCS Patient Record Form (line 10) New 100 23 0 Form none 2011 Pretest NAMCS Patient Record
2011 Pretest Physician Induction Interview (line 8) New 100 58 0 Form none 2011 Pretest Physician Induction Interview
2012 Asthma Supplement (line 5) New 669 167 0 Form none 2012 Asthma Supplement
NAMCS EMR/EHR Mail Survey (Line 6) Modified 5460 1820 0 Form none NAMCS - EMR Supplement 2011
NAMCS-1 Physician Induction Interview (Line 1) Modified 5012 2339 0 Form and Instruction none National Ambulatory Medical Care Survey 2011 Parnel - NAMCS 1
NAMCS-201 Community Health Center Induction Interview (Line 2) Modified 104 35 0 Form none Community Health Center Induction Interview 2011
NAMCS-30 Patient Record form (Line 3) Modified 30510 5594 0 Form none NAMCS 2011 Patient Record Folio
NAMCS-CCS Cervical Cancer Screening Supplement (Line 5) Removed 0 0 0 Form 5 NAMCS-CCS Cervical Cancer Screening Supplement (Line 5)
Physician Workflow Survey (line 7) New 2982 994 0 Form none Physician Workflow Survey - EHR/no EHR Supplement 2
Form none Physician Workflow Survey - EHR/no EHR Supplement 2
Pulling and re-filing Patient Record form (Line 4) Modified 26790 447 0 Form none Pulling and Refiling of Patient Record
Total burden requested under this ICR: 71827 11502 0  
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