Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
2012 Asthma Supplement (line 6) Modified 10554 3518 0 Form none Att B - Asthma Supplement
2012 CPT Pretest NAMCS-1 (line 9) Modified 17 10 0 Form none Att Z - NAMCS 2011 Panel CPT Code Pretest
2012 Pretest NAMCS Patient Record Form (line 10) Modified 17 4 0 Form none Att BB - NAMCS 2012 - Patient Record Form CPT Code Pretest
Lookback Module (Line 5) Modified 5683 947 0 Form none Att E - 2012 NAMCS Lookback Module
NAMCS-1 Physician Induction Interview (Line 1) Modified 16237 9472 0 Form none National Ambulatory Medical Care Survey Panel 2011
NAMCS-201 Community Health Center Induction Interview (Line 2) Modified 2008 669 0 Form none Att K - Community Health Center Induction Interview
NAMCS-30 Patient Record form (Line 3) Modified 97440 22736 0 Form none Att H - NAMCS 2012 Patient Record
National Electronic Health Records Survey (line 7) Modified 4344 1448 0 Form none National Electronic Health Records Survey 2012
Physician Workflow Survey (line 8) Modified 2645 1323 0 Form none Att N - 2012 Physician Workflow Supplement - EHR Adopters
Form none Att O - 2012 Physician Workflow Supplelment - EHR Nonadopters
Pulling and re-filing Patient Record form (Line 4) Modified 389670 6495 0 Instruction
Total burden requested under this ICR: 528615 46622 0  
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