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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
[NCHS] Adding Incentives Experiments to the Direct Care Worker Pilot Study
Agency IC Tracking Number:
0920-1030-24EF
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
Instruction
Att A-1 Director Incentive_Cover Letter_final.docx
Yes
No
Fillable Fileable
Form and Instruction
n/a
DCW Questionnaire
Att B DCW question List.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:
FR Citation:
Number of Respondents:
254
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits, Not-for-profit institutions
Percentage of Respondents Reporting Electronically:
90 %
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
254
0
254
0
0
0
Annual IC Time Burden (Hours)
50
0
50
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
DCW Incentive Cover Letter
Att A-2 DCW Incentive_Cover Letter.docx
03/27/2024
NCHS Confidential Brochure
Att A-3 NCHS Confidential Brochure.docx
03/27/2024
DCW Thank You Letter
Att C DCW Thank You letter.docx
03/27/2024
HS Determination
Att D Human Subjects Determination.docx
03/27/2024
DCW Pilot Flyer
Att E_DCW Pilot Flyer.pdf
03/27/2024
SSA
NPALS DCW Pilot Supp State A_Incentives_final.docx
03/27/2024
SSB
NPALS DCW Pilot Supp State B_Incentives_final.docx
03/27/2024
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.