View Information Collection Request (ICR) Package
Skip to main content
An official website of the United States government
The .gov means it's official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.
The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.
Search:
Agenda
Reg Review
ICR
This script is used to control the display of information in this page.
Display additional information by clicking on the following:
All
Brief and OIRA conclusion
Abstract/Justification
Legal Statutes
Rulemaking
FR Notices/Comments
IC List
Burden
Misc.
Common Form Info.
Certification
View Information Collection (IC) List
View Supporting Statement and Other Documents
Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
0920-0278
ICR Reference No:
201011-0920-002
Status:
Historical Active
Previous ICR Reference No:
201007-0920-004
Agency/Subagency:
HHS/CDC
Agency Tracking No:
Title:
National Hospital Ambulatory Medical Care Survey
Type of Information Collection:
No material or nonsubstantive change to a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
12/02/2010
Retrieve Notice of Action (NOA)
Date Received in OIRA:
11/02/2010
Terms of Clearance:
Cleared on the understanding that NCHS and ONC staff have committed to consult with OMB during the development of the next iteration of the EHR/EMR component for NAMCS/HAMCS.
Inventory as of this Action
Requested
Previously Approved
Expiration Date
08/31/2012
08/31/2012
08/31/2012
Responses
128,141
0
128,141
Time Burden (Hours)
12,112
0
12,112
Cost Burden (Dollars)
0
0
0
Abstract:
This request is to modify/add selected questions on Electronic medical record usage and delete the cancer supplement starting in 2011 to the ongoing OMB 0920-0278 -National Hospital Ambulatory Medical Care Survey (NHAMCS).
Authorizing Statute(s):
US Code:
42 USC 306
Name of Law: Public Health Service Act
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
8
IC Title
Form No.
Form Name
ASC Patient Record Form
unnumbered
Att. O. ASC Patient Record Form
Ambulatory Unit Record
unnumbered, none
Att. J. Ambulatory Unit Induction Form
,
Att. J. Ambulatory Unit Induction Form - 11/29/2010
Cervical Cancer Screening Supplement
unnumbered
Att. T. Cervical Cancer Screening Supplement
ED Patient Record Form
unnumbered
Att. M. ED Patient Record Form
Freestanding ASC Induction Form
none, none
Freestanding Ambulatory Surgery Centers Form
,
Freestanding Ambulatory Surgery Centers Form - 11/29/2010
Hospital Induction Form
none, none
Hospital Induction Form
,
Hospital Induction Form - 11/29/2010
OPD Patient Record Form
none, none
OPD Patient Record
,
OPD Patient Record - 11/29/2010
Pulling and re-filing Patient Records
ICR Summary of Burden
Total Approved
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in Estimate
Change Due to Potential Violation of the PRA
Annual Number of Responses
128,141
128,141
0
0
0
0
Annual Time Burden (Hours)
12,112
12,112
0
0
0
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
No
Burden Increase Due to:
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
Annual Cost to Federal Government:
$4,473,000
Does this IC contain surveys, censuses, or employ statistical methods?
Yes
Part B of Supporting Statement
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
No
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
No
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
No
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
Yes
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
Carol Walker 4046394773
Common Form ICR:
No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date:
11/02/2010
Something went wrong when downloading this file. If you have any questions, please send an email to risc@gsa.gov.