View Information Collection Request (ICR) Package
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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:
0920-0234
ICR Reference No:
201309-0920-004
Status:
Historical Active
Previous ICR Reference No:
201211-0920-001
Agency/Subagency:
HHS/CDC
Agency Tracking No:
20471
Title:
National 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:
11/04/2013
Retrieve Notice of Action (NOA)
Date Received in OIRA:
09/10/2013
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
12/31/2014
12/31/2014
12/31/2014
Responses
553,650
0
571,530
Time Burden (Hours)
47,943
0
50,923
Cost Burden (Dollars)
0
0
0
Abstract:
This request is for a nonsubstantive change to modify selected sections of the 2012-2014 National Ambulatory Medical Care Survey to colelct new and/or updated information. Minor changes have been made to two survey insturments, and one module (the lookback) was removed.
Authorizing Statute(s):
US Code:
42 USC 242K
Name of Law: Public Health Service Act
PL:
Pub.L. 111 - 5 1512
Name of Law: American Recovery and Reinvestment Act of 2009
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?
Yes
Number of Information Collection (IC) in this ICR:
10
IC Title
Form No.
Form Name
2012 Asthma Supplement (line 6)
none
Att B - Asthma Supplement
2012 CPT Pretest NAMCS-1 (line 9)
none
Att Z - NAMCS 2011 Panel CPT Code Pretest
2012 Pretest NAMCS Patient Record Form (line 10)
none
Att BB - NAMCS 2012 - Patient Record Form CPT Code Pretest
Lookback Module (Line 5)
None
National Ambulatory Medical Care Survey 2013 Look Back Module
NAMCS-1 Physician Induction Interview (Line 1)
none
NAMCS-1 Induction Interview
NAMCS-201 Community Health Center Induction Interview (Line 2)
none
Att K - Community Health Center Induction Interview
NAMCS-30 Patient Record form (Line 3)
none
Patient Record Form
National Electronic Health Records Survey (line 7)
None
National Electronic Health Records Survey 2013
Physician Workflow Survey (line 8)
None, None
E. Physician Workflow Survey Year 2013 (EHR adopters)
,
F. Physician Workflow Survey Year 2013 (EHR nonadopters)
Pulling and re-filing Patient Record form (Line 4)
Re-abstraction Study
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
553,650
571,530
0
-17,880
0
0
Annual Time Burden (Hours)
47,943
50,923
0
-2,980
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:
Yes
Burden Reduction Due to:
Miscellaneous Actions
Short Statement:
One module (lookback) was removed.
Annual Cost to Federal Government:
$11,399,149
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]?
Yes
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:
Shari Steinberg 404 639-4942 sxw2@cdc.gov
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:
09/10/2013
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