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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
National Study of Long-Term Care Providers Feasibility Project to Collect Person-Level Data from Residential Care Communities and Adult Day Services Centers
Agency IC Tracking Number:
16ST
IC Status:
New
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
0920-1030
Attachment C Second call script-sampling interview and probing
Attachment B First call script--screening 030116.docx
Yes
Yes
Fillable Printable
Form and Instruction
0920-1030
Attachment C Second call script-sampling interview and probing
Attachment C Second call script-sampling interview and probing 030116.docx
Yes
Yes
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
Health Resources Utiliztion Statistics
FR Citation:
49 FR 37697
Number of Respondents:
90
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
90
0
90
0
0
0
Annual IC Time Burden (Hours)
91
0
91
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
NSLTCP Feasibility Project SSA
NSLTCP Feasibility Project SSA 022916.doc
03/02/2016
NSLTCP Feasibility Project SSB
NSLTCP Feasibility Project SSB 022916.doc
03/02/2016
Attachment A ERB Approval Letter
Attachment A ERB Approval Letter 1-8-16.docx
03/02/2016
Attachment D-1 Advance Package
Attachment D-1 Advance Package 1-19-16.docx
03/02/2016
Attachment D-2 Pre-Appointment Package
Attachment D-2 Pre-Appointment Package 1-7-16.docx
03/02/2016
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.