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
HC Facility Interview (2021-2023) New 92 69 0 Form and Instruction 0920-0234
Induction Interview - Community Health Center Providers Removed 0 0 0 Form and Instruction none
Form and Instruction none
Instruction
Induction Interview - Service Delivery Site (NAMCS-201) Removed 0 0 0 Form and Instruction none
Form and Instruction none
Form and Instruction none
MU Physician Pulling and Refiling EHR Removed 0 0 0 Instruction
PFI (2021-2023) New 2000 1500 0 Form and Instruction 0920-0234
Physician Induction Interview (2020) Modified 500 250 0 Form and Instruction 0920-0234
Physician Induction Interview (2021-2023) New 3000 1500 0 Form and Instruction 0920-0234
Prepare and transmit EHR for Visit Data (quarterly) (2021-2023) New 368 368 0 Form and Instruction 0920-0234
Provider Induction Interview (2020) Modified 52 26 0 Form and Instruction 0920-0234
Pulling and Refiling Medical Record Forms EHR Onboarding) (2021-2023) Modified 2000 2000 0 Form and Instruction 0920-2034
Pulling, re-filing medical record forms (FR abstracts) (2020) Modified 1560 26 0 Form 0920-0234
Form and Instruction 0920-0234
Pulling, re-filing medical record forms (FR abstracts) (2021-2023) New 60000 1000 0 Form and Instruction 0920-0234
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 - Traditional Physician and CHC Staff Modified 33 8 0 Form 0920-0234
Total burden requested under this ICR: 69872 6819 0  
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