Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
HC Facility Induction Interview (2020) Modified 17 9 0 Form and Instruction 0920-0234 Att F1- 2020 NAMCS-201 CHC Service Delivery Site
HC Facility Interview (2021-2023) New 92 69 0 Form and Instruction 0920-0234 CHC Facility Interview Questionnaire
Induction Interview - Community Health Center Providers Removed 0 0 0 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) Removed 0 0 0 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 Pulling and Refiling EHR Removed 0 0 0 Instruction
PFI (2021-2023) New 2000 1500 0 Form and Instruction 0920-0234 Att C2- 2021 NAMCS-1 Traditional Physician
Physician Induction Interview (2020) Modified 500 250 0 Form and Instruction 0920-0234 Att P2- 2021 Census Reinterview Instrument
Physician Induction Interview (2021-2023) New 3000 1500 0 Form and Instruction 0920-0234 Physician Induction Interview (2021-2023)
Prepare and transmit EHR for Visit Data (quarterly) (2021-2023) New 368 368 0 Form and Instruction 0920-0234 EHR Pulling Records
Provider Induction Interview (2020) Modified 52 26 0 Form and Instruction 0920-0234 HC Facility Induction Interview (2020)
Pulling and Refiling Medical Record Forms EHR Onboarding) (2021-2023) Modified 2000 2000 0 Form and Instruction 0920-2034 EHR Pulling Records Burden
Pulling, re-filing medical record forms (FR abstracts) (2020) Modified 1560 26 0 Form 0920-0234 Att R- 2021 EHR Pulling Records Burden
Form and Instruction 0920-0234 PRF Burden Abstract
Pulling, re-filing medical record forms (FR abstracts) (2021-2023) New 60000 1000 0 Form and Instruction 0920-0234 Att C2- 2021 NAMCS-1 Traditional Physician
Reabstraction Study - Traditional and CHC Providers Removed 0 0 0 Instruction
Instruction
Reinterview Study (2021-2023) New 250 63 0 Form and Instruction 0920-0234 Reinterview Study (2021-2023)
Reinterview Study - Traditional Physician and CHC Staff Modified 33 8 0 Form 0920-0234 2020 Reinterview Instrument
Total burden requested under this ICR: 69872 6819 0  
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