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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
[NCHS] Direct Care Worker Pilot Study
Agency IC Tracking Number:
0920-1030-23FI
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
n/a
Director Sampling Appointment Setting Call
Att B-1 Director Sampling Appointment Setting Call 5.11.23_final.docx
No
Fillable Fileable
Form and Instruction
n/a
Director DCS Sampling Call
Att B-3 Director DCW Sampling Call 5.11.23_final.docx
No
Fillable Fileable
Form and Instruction
n/a
DCW Draft Question List
Att C DCW draft question List 5.11.23_final.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
Health Resources Utilization Statistics
FR Citation:
59 FR 48331
Number of Respondents:
1,440
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
40 %
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
1,440
0
1,440
0
0
0
Annual IC Time Burden (Hours)
480
0
480
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Director Mailing Cover Letter with FAQs
Att A-1 Director mailing NCHS Cover Letter with FAQs 5.17.23.docx
05/22/2023
DCW Mailing Cover Letter with FAQs
Att A-2 DCW NCHS Cover Letter with FAQs 5.17.23.docx
05/22/2023
Strictly Confidential Brochure
Att A-3 NCHS Strictly Confidential Brochure 5.11.23.docx
05/22/2023
CATI Confirmation and Prep Letter/Email
Att B-2 CATI Confirmation and Prep Letter or email.docx
05/22/2023
Thank You Reminder Letters
Att D-1 Thank You Reminder letters 5.17.23.docx
05/22/2023
Prompting Letters
Att D-2 Prompting emails 5.17.23.docx
05/22/2023
Human Subjects Determination
Att E Human Subjects Determination 5.17.23.docx
05/22/2023
SSA
NPALS DCW Pilot Supp State A_5.16.23_final.docx
05/22/2023
SSB
NPALS DCW Pilot Supp State B_5.16.23.docx
05/22/2023
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.