National Hospital Ambulatory Medical Care Survey

Forms and Documents

Document Name	Status

No forms / supporting documents in this ICR. Check IC Document Collections.

IC Document Collections

IC ID	Document Title	Status
6726	National Hospital Ambulatory Medical Care Survey Form	Migrated

ICR Details

OMB Control No: 0920-0278	ICR Reference No: 199605-0920-006
Status: Historical Active	Previous ICR Reference No: 199405-0920-004
Agency/Subagency: HHS/CDC	Agency Tracking No:
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: 07/19/1996
	Date Received in OIRA: 05/23/1996
Terms of Clearance: Approved for use through 7/99 under the following conditions: 1) as with the NHIS, no later than 7/96 NCHS provides to OMB a crosswalk between the Injury sections on the patient abstract sheet and the ICD-10 and NOMESCO classification systems; 2) no later than 12/96, NCHS provides OMB an analysis of the Injury sections as they relate to the forthcoming third revised edition of the NOMESCO classification that will be published in the Fall of 1996 as a Trial Version of the International Classification of External Causes of Injury in collaboration with the World Health Organization; 3) NCHS immediately incorporates all disclosure statements mandated pursuant to the Paperwork Reduction Act of 1995 and implementing regulations. The revised forms/ instructions incorporating these disclosures must be provided to OMB; and 4) prior to the next submission for OMB review, NCHS briefs OMB on the status of its efforts to include its series of provider-based surveys in the Department's Data Consolidation initiative. Finally, OMB encourages NCHS to continue its analytic contributions to policymaking throughout the Department (in particular providing HCFA its survey expertise and analysis based on provider surveys.) OMB continues to evaluate the practical utility of these provider-based surveys in terms of their impact on the rigor and quality of HHS policy development.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/1999	07/31/1999	07/31/1997
Responses	26,088	0	91,840
Time Burden (Hours)	7,069	0	8,572
Cost Burden (Dollars)	0	0	0

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Abstract: Data collected from hospital outpatient departments and emergency departments concerning patient visits are agregated to national statistics. The data are used by the public and parivate sectors for public health planning, medical education, health manpower assessment, epidemiologic studies and other medical utilization research.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
National Hospital Ambulatory Medical Care Survey	101, 101U

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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	26,088	91,840	0	0	-65,752	0
Annual Time Burden (Hours)	7,069	8,572	0	0	-1,503	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:

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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

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Common Form ICR:  No

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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: 05/23/1996

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