Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
2012 Asthma Supplement (line 6) Modified 11072 3691 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 510 119 0 Form none Att BB - NAMCS 2012 - Patient Record Form CPT Code Pretest
Lookback Module (Line 5) Removed 0 0 0 Form None National Ambulatory Medical Care Survey 2013 Look Back Module
NAMCS-1 Physician Induction Interview (Line 1) Modified 17034 9937 0 Form none NAMCS-1 Induction Interview
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 102210 23849 0 Form none Patient Record Form
National Electronic Health Records Survey (line 7) Modified 4344 1448 0 Form None National Electronic Health Records Survey 2013
Physician Workflow Survey (line 8) Modified 2645 1323 0 Form None E. Physician Workflow Survey Year 2013 (EHR adopters)
Form None F. Physician Workflow Survey Year 2013 (EHR nonadopters)
Pulling and re-filing Patient Record form (Line 4) Modified 408810 6814 0 Instruction
Re-abstraction Study Modified 5000 83 0 Instruction
Total burden requested under this ICR: 553650 47943 0  
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