Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
(ACPI) Advanced Practice Provider and their Proxies (Survey year: 2025 & 2027) Modified 6667 1667 0 Form and Instruction 0920-0234 NAMCS Ambulatory Care Provider Interview (ACPI) Advanced Practice Provider and their Proxies
Form and Instruction 0920-0234 NAMCS Ambulatory Care Provider Interview (ACPI) Advanced Practice Provider Interview_10JAN2025
EHR for Visit Data (quarterly) (Survey year: 2025-2027)_ACP staff Modified 12000 12000 0 Form and Instruction 0920-0234 EHR Implementation Guide Templates
Form and Instruction 0920-0234 Attachment O2_NAMCS EHR Record Pulling Burden
(ACPI) Providers and their Proxies (Survey year: 2026) Modified 3333 833 0 Form and Instruction 0920-0234 NAMCS Provider Facility Interview (PFI)
Form and Instruction 0920-0234 NAMCS Ambulatory Care Provider Interview (ACPI) Providers and their Proxies_10JAN2025
EHR for Visit Data (quarterly) (2024) Modified 200 200 0 Form and Instruction 0920-0234 NAMCS Electronic Health Record (EHR): Pulling and Sending Records
Form and Instruction 0920-0234 National Health Care Surveys Release 1
Form and Instruction 0920-0234 HL7 CDA® R2 Implementation Guide: National Health Care Surveys Release 1,
EHR for Visit Data (quarterly) (Survey yr: 2025-2027)_HC staff Modified 752 752 0 Form and Instruction 0920-0234 EHR Implementation Guide Templates
Form and Instruction 0920-0234 EHR Implementation Guide
Health Center Component Facility Interview (Survey year: 2024) Modified 84 63 0 Form and Instruction 0920-0234 2024 Health Center Component Facility Interview
Health Center Component Facility Interview (Survey year: 2025 & 2027) Modified 221 166 0 Form and Instruction 0920-0234 2025-2027 Health Center Component Facility Interview
NAMCS Provider Facility Interview (PFI) (Survey year: 2025 & 2027) Modified 3000 2250 0 Form and Instruction 0920-0234 NAMCS Provider Facility Interview (PFI)
Form and Instruction 0920-0234 NAMCS Provider Facility Interview (PFI)_10JAN2025
NAMCS Tracing Questionnaire (Survey year: 2025 & 2027) _ Advanced Modified 6667 1111 0 Form and Instruction 0920-0234 NAMCS Tracing Questionnaire (Survey year 2025 & 2027)
NAMCS Tracing Questionnaire (Survey year: 2026) Modified 3333 556 0 Form and Instruction 0920-0234 NAMCS Tracing Questionnaire
Set-up Fee Questionnaire (H/C staff) (Survey year: 2024) Modified 17 4 0 Form and Instruction 0920-0234 Set-up Fee Questionnaire (2024)
Set-up Fee Questionnaire (H/C staff) (Survey year: 2025-2027) Modified 17 4 0 Form and Instruction 0920-0234 Set-up Fee Questionnaire
Total burden requested under this ICR: 36291 19606 0  
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