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:
0920-0278
ICR Reference No:
201412-0920-013
Status:
Historical Active
Previous ICR Reference No:
201311-0920-002
Agency/Subagency:
HHS/CDC
Agency Tracking No:
20786
Title:
National Hospital Ambulatory Medical Care Survey
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
02/06/2015
Retrieve Notice of Action (NOA)
Date Received in OIRA:
12/29/2014
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
02/28/2018
36 Months From Approved
02/28/2015
Responses
105,768
0
132,443
Time Burden (Hours)
4,412
0
7,352
Cost Burden (Dollars)
0
0
0
Abstract:
This request is for the revision of an approved data collection (OMB No. 0920-0278), the National Hospital Ambulatory Medical Care Survey (NHAMCS). NCHS requests to continue the survey activities for NHAMCS for 3 years and slightly modify survey activities. NHAMCS is a national survey of patient visits to emergency departments, outpatient departments, and ambulatory surgery locations of general and short-stay hospitals. The revisions included in this request entail making slight modifications to NHAMCS questions.
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
60-day Notice:
Federal Register Citation:
Citation Date:
79 FR 49520
08/21/2014
30-day Notice:
Federal Register Citation:
Citation Date:
79 FR 77495
12/24/2014
Did the Agency receive public comments on this ICR?
Yes
Number of Information Collection (IC) in this ICR:
8
IC Title
Form No.
Form Name
ASL Patient Record Form
none
Ambulatory Surgery
Ambulatory Surgery Center Patient Record Form
None
NHAMCS Ambulatory Surgery Center Patient Record Form
Ambulatory Unit Induction
Ambulatory Unit Induction Interview
None
NHAMCS Ambulatory Unit Induction Form
ED Patient Record Form
none
ED Screenshots
Emergency Department Patient Record Form
None
NHAMCS Emergency Department Patient Record Form
Hospital Induction Form
none
Hospital Induction Interview
Hospital Induction Interview
None
NHAMCS Hospital Induction Form
Medical Record Reabstraction
OPD Patient Record Form
none
OPD Screenshots
Outpatient Department Patient Record Form
None
NHAMCS Outpatient Department Patient Record Form
Pulling and re-filing Patient Records
Reabstraction Telephone Call
Reabstraction Telephone Call
Retrieve Medical Records
Retrieve Medical Records Records (Reabstraction)
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
105,768
132,443
0
-24,896
-1,779
0
Annual Time Burden (Hours)
4,412
7,352
0
-2,495
-445
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
Yes
Burden Increase Due to:
Miscellaneous Actions
Burden decreases because of Program Change due to Agency Discretion:
Yes
Burden Reduction Due to:
Miscellaneous Actions
Short Statement:
Reduction in Burden Hours in this ICR Revision is due to changes to surveys associated with the ICR as well as increased use of Field Representative abstraction of records.
Annual Cost to Federal Government:
$6,289,206
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?
Yes
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:
Jeffrey Zirger 404 639-7118 wtj5@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:
12/29/2014
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