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Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
ACPI
New
11667
5834
0
Form and Instruction
0920-0234
ACPI
Advance Practice ACPI
New
21667
10834
0
Form and Instruction
0920-0234
Advanced Practice ACPI
Contact Tracing
New
21667
3611
0
Form and Instruction
0920-0234
Tracing Questionnaire
Contact Tracing
New
11667
1945
0
Form and Instruction
0920-0234
Tracing Questionnaire
HC Facility Interview 2022
Modified
73
55
0
Form and Instruction
0920-0234
Health Center (HC) Facility Interview
HC Facility Interview (2023-2025)
Modified
300
225
0
Form and Instruction
0920-0234
HC Facility Interview questionnaire
PFI (2023- 2025)
Modified
3000
2250
0
Form and Instruction
0920-0234
PFI (2023-2025)
Physician Induction Interview (2020)
Removed
0
0
0
Form and Instruction
0920-0234
Att P2- 2021 Census Reinterview Instrument
Physician Induction Interview (2021-2023)
Removed
0
0
0
Form and Instruction
0920-0234
Physician Induction Interview (2021-2023)
Prepare and transmit EHR for Visit Data (quarterly) (2022)
New
12000
12000
0
Form and Instruction
0920-0234
Attachment O1_NAMCS EHR Record Pulling Burden
Form and Instruction
0920-0234
Attachment O2_NAMCS EHR Record Pulling Burden
Prepare and transmit EHR for Visit Data (quarterly) (2022)
Modified
132
132
0
Form and Instruction
0920-0234
Attachment O1_NAMCS EHR Record Pulling Burden
Prepare and transmit EHR for Visit Data (quarterly) (2023-2025)
New
800
800
0
Form and Instruction
0920-0234
Attachment O1_NAMCS EHR Record Pulling Burden
Provider Induction Interview (2020)
Removed
0
0
0
Form and Instruction
0920-0234
HC Facility Induction Interview (2020)
Pulling and Refiling Medical Record Forms EHR Onboarding) (2021-2023)
Removed
0
0
0
Form and Instruction
0920-2034
EHR Pulling Records Burden
Pulling, re-filing medical record forms (FR abstracts) (2020)
Removed
0
0
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)
Removed
0
0
0
Form and Instruction
0920-0234
Att C2- 2021 NAMCS-1 Traditional Physician
Reinterview Study (2021-2023)
Removed
0
0
0
Form and Instruction
0920-0234
Reinterview Study (2021-2023)
Reinterview Study - Traditional Physician and CHC Staff
Removed
0
0
0
Form
0920-0234
2020 Reinterview Instrument
Set-up Fee Questionnaire
New
33
8
0
Form and Instruction
0920-0234
Attachment J_Set-up Fee Questionnaire
Set-up Fee Questionnaire (2023-2025)
New
200
50
0
Form and Instruction
0920-0234
Attachment J_Set-up Fee Questionnaire
Total burden requested under this ICR:
83206
37744
0
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