Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
2012 Asthma Supplement (line 6) Removed 0 0 0 Form none Att B - Asthma Supplement
2012 CPT Pretest NAMCS-1 (line 9) Removed 0 0 0 Form none Att Z - NAMCS 2011 Panel CPT Code Pretest
2012 Pretest NAMCS Patient Record Form (line 10) Removed 0 0 0 Form none Att BB - NAMCS 2012 - Patient Record Form CPT Code Pretest
2015 Patient Record Form - Pulling and Refiling New 5000 83 0 Other-Burden Placeholder
NAMCS-1 Physician Induction Interview (Line 1) Removed 0 0 0 Form none NAMCS-1 Induction Interview
NAMCS-201 CHC Service Delivery Induction New 1780 593 0 Form none CHC Induction Survey
NAMCS-201 Community Health Center Induction Interview (Line 2) Removed 0 0 0 Form none Att K - Community Health Center Induction Interview
NAMCS-30 Patient Record Form New 57960 13524 0 Form none NAMCS-30 Form
Form none NAMCS-30 Card
NAMCS-30 Patient Record form (Line 3) Removed 0 0 0 Form none Patient Record Form
National Electronic Health Records Survey (line 7) Removed 0 0 0 Form None National Electronic Health Records Survey 2013
Physician Induction Inverview (NAMCS-1) New 9661 7246 0 Form none NAMCS 1
Physician Workflow Survey (line 8) Removed 0 0 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) Removed 0 0 0 Instruction
Re-abstraction Study: Pulling & Refiling Medical Records New 231870 3865 0 Other-Burden Placeholder
Re-abstraction Study Removed 0 0 0 Instruction
Total burden requested under this ICR: 306271 25311 0  
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