Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
2018 Physician Induction Inverview (NAMCS-1) Modified 122 61 6323 Form and Instruction none 2018Traditional Physician Induction Sample Card
2019 Traditional Provider Induction Interview (NAMCS-1) Modified 1097 549 17640 Form and Instruction none 2019 NAMCS-1 Questions for Traditional Physicians
Instruction
Form none Sample 2019 Patient Record
Induction Interview - Community Health Center Providers New 348 174 15267 Form and Instruction none 2018 CHC Provider Induction Sample Card
Form and Instruction none 2019 CDC Provider Questions
Instruction
Induction Interview - Service Delivery Site (NAMCS-201) Modified 116 58 5250 Form and Instruction none 2018 CHC Provider Induction Sample Card
Form and Instruction none 2019 CHC Provider Induction Interview
Form and Instruction none CDC Service Delivery Induction Interview Sample Card
MU Physician Induction Interview Modified 2000 1500 48240 Form and Instruction none NAMCS-PFI Questions for MU Physicians
MU Physician Pulling and Refiling EHR New 2000 2000 64320 Instruction
Patient Record Form (NAMCS-1) Removed 0 0 0 Form and Instruction 0920-0234 Att D2 2016 NAMCS PRF
Physician Abstracts -Patient Record Form (NAMCS-30) Removed 0 0 0 Form and Instruction 0920-0234 Att D2 2016 NAMCS PRF 122115
Pulling and Refiling Medical Record Forms - CHC Provider and Staff Modified 10440 174 5638 Instruction
Pulling and Refiling Medical Record Forms - Tradtional Providers Modified 29760 496 16070 Instruction
Reabstraction Study - Traditional and CHC Providers Modified 30 1 16 Instruction
Instruction
Reinterview Study - Traditional Physician and CHC Staff New 100 25 804 Form and Instruction none Reinterview Study Questionnaire
Total burden requested under this ICR: 46013 5038 179568  
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