Abstract: This report presents the results of the cognitive evaluation of the 2015 National Electronic Health Records Survey (NEHRS), which is an annual supplement of the ongoing National Ambulatory Medical Care Survey (NAMCS). The NEHRS is a national survey of office-based physicians conducted by the National Center for Health Statistics, and is sponsored by the Office of the National Coordinator for Health Information Technology (ONC) in the Department of Health and Human Services (DHHS). NEHRS is primarily concerned with the adoption of electronic health records (EHRs, also commonly known as EMRs by physicians, standing for electronic medical records) and the meaningful use standards set by DHHS. NEHRS is partially funded by the American Recovery and Reinvestment Act of 2009 (which includes the Health Information Technology for Economic and Clinical Health, or HITECH, Act), as well as the Patient Protection and Affordable Care Act of 2010 (ACA) . The aim of both the HITECH Act and the ACA is to enhance efficiency and to improve quality in the health care system, including increasing the adoption rate of electronic health records, expanding access to care, and improving patient health. NEHRS provides key information that allows DHHS to evaluate and implement the electronic health records provisions laid out in ARRA and ACA. In consultation with both the Division of Health Care Surveys at NCHS and ONC, the Center for Questionnaire Design and Evaluation Research (CQDER) designed and conducted a cognitive and usability evaluation of the 2015 NHERS self-report paper-based instrument. The instrument (see Appendix A) is eight pages long, and includes 41 numbered questions. There are nine “table format” questions, which present sub-questions as row headers and answer categories as column headers. Given this high number of table questions, as well as the overall length of the questionnaire, this evaluation project focused not just on the response processes behind the questionnaire items, but also on the instrument’s overall usability. This report first presents a brief overview of cognitive interviewing methodology and the theory behind the question response process, and then describes the research design for this particular project. Overall, cross-item findings are then discussed, and finally a question-by-question analysis is presented.