National Hospital Ambulatory Medical Care Survey

Forms and Documents

Document Name	Status
0920-0278 Attach_C_NHAMCS_Bioterrorism-Advanced_Data_Report[1].pdf Supplementary Document	2007-09-05
NHAMCS 83-C pandemic 08 09 (4).doc Justification for No Material/Nonsubstantive Change	2007-08-16
0920-0278 Supporting_Statement_6-23-06[1].doc Supporting Statement A	2007-09-05

IC Document Collections

IC ID	Document Title	Status
43613	Ancillary Service Executive/Hospital Induction Pandemic and Emergency Response Preparedness Questions Instruction	Modified
181869	Medical Record Clerk/ Pulling and re-filing OPD Patient Record Instruction	New
181868	Medical Record Clerk/ Pulling and re-filing ED Patient Record Instruction	New
181867	Physician/ Registered Nurse/Medical Record Clerk OPD Patient Record Form Instruction	New
181866	Ancillary Service Executive/Ambulatory Unit Induction (OPD) Instruction	New
181865	Physcian/Registered Nurse Medical Record Clerk ED Patient Record Form Instruction	New
181864	Hospital Chief Medical Officer/Ancillary Service Executive/Hospital Induction/Ambulatory Unit Induction (ED) Instruction	New
181863	Hospital Chief Medical Officer/Physician Assistant/Nurse Practitioner Hospital Induction(Ineligible)/Cervical Cancer Screening Supplement Instruction	New

ICR Details

OMB Control No: 0920-0278	ICR Reference No: 200709-0920-001
Status: Historical Active	Previous ICR Reference No: 200607-0920-002
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: 09/11/2007
	Date Received in OIRA: 09/05/2007
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2009	08/31/2009	08/31/2009
Responses	90,031	0	92,120
Time Burden (Hours)	7,312	0	7,313
Cost Burden (Dollars)	0	0	0

---

Abstract: Data collected from hospital emergency and outpatient departments concerning patient visits are weighted to produce national estimates. The data are used by the public and private sectors for public health planning, medical education, health work force assessment, epidemiologic studies, and health service research.

---

Authorizing Statute(s): None

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
Hospital Chief Medical Officer/Physician Assistant/Nurse Practitioner Hospital Induction(Ineligible)/Cervical Cancer Screening Supplement
Hospital Chief Medical Officer/Ancillary Service Executive/Hospital Induction/Ambulatory Unit Induction (ED)
Physcian/Registered Nurse Medical Record Clerk ED Patient Record Form
Ancillary Service Executive/Hospital Induction Pandemic and Emergency Response Preparedness Questions
Medical Record Clerk/ Pulling and re-filing ED Patient Record
Medical Record Clerk/ Pulling and re-filing OPD Patient Record
Ancillary Service Executive/Ambulatory Unit Induction (OPD)
Physician/ Registered Nurse/Medical Record Clerk OPD Patient Record Form

---

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	90,031	92,120	0	-2,089	0	0
Annual Time Burden (Hours)	7,312	7,313	0	-1	0	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: This submission includes the addition of "Pandemic and Emergency Response Preparedness Supplement" to the 2008 National Hospital Ambulatory Medical Care Survey. The respondents are thos facilities currently in the sample. The currently approved annual burden is 7,313 hours. The addition of 190 hours to complete the pandemic and emergency response preparedness questions will result in the same burden as currently approved, due to response rates decreasing. Please be advised that the instrument attached to each Part II is the same,the burden time for each respondent type will vary, as it depends on the position as to how what questions will be asked of them.

---

Annual Cost to Federal Government: $0

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]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

---

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: 09/05/2007

---