View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	2019 Traditional Provider Induction Interview (NAMCS-1)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	none	2019 NAMCS-1 Questions for Traditional Physicians	Att C1-2019 NAMCS 1 TradPhys 012519.docx		Yes	Yes	Fillable Fileable
Instruction			Att C3-2019 Induction Sample Card TradPhy.docx		Yes	Yes	Fillable Fileable
Form	none	Sample 2019 Patient Record	Att F-2019 Patient Record Form (NAMCS-73).pdf		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Human Resources Utilization 09-20-0167	FR Citation: 49 FR 37697

Number of Respondents: 1,097	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	1,097	0	863	0	0	234
Annual IC Time Burden (Hours)	549	0	432	0	0	117
Annual IC Cost Burden (Dollars)	17,640	0	17,640	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.