View Information Collection Request (ICR) Package
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View Information Collection (IC) List
View Supporting Statement and Other Documents
Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
0920-0943
ICR Reference No:
201206-0920-004
Status:
Historical Active
Previous ICR Reference No:
Agency/Subagency:
HHS/CDC
Agency Tracking No:
Title:
Data Collection for the Residential Care Community and Adult Day Services Center Components of the National Study of Long-term Care Providers
Type of Information Collection:
New collection (Request for a new OMB Control Number)
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved with change
Conclusion Date:
07/30/2012
Retrieve Notice of Action (NOA)
Date Received in OIRA:
06/20/2012
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
07/31/2015
12 Months From Approved
Responses
18,371
0
0
Time Burden (Hours)
8,769
0
0
Cost Burden (Dollars)
0
0
0
Abstract:
NCHS seeks approval to collect data for the residential care community (RCC) and adult day services center (ADSC) components of a new study, the National Study of Long-Term Care Providers (NSLTCP). Data from RCCs and ADSCs include basic characteristics, services offered, staffing, and practices of providers, and distributions of the demographics, physical functioning, and cognitive functioning of users (RCC residents and ADSC participants) aggregated to the RCC/ADSC level. The study will be administered by mail, web, and telephone to a sample of 11,701 RCCs and a census of 5,000 ADSCs in the 50 states and the District of Columbia.
Authorizing Statute(s):
US Code:
42 USC 242k
Name of Law: Public Health Service Act
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
76 FR 78261
12/16/2011
30-day Notice:
Federal Register Citation:
Citation Date:
77 FR 33745
06/07/2012
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
3
IC Title
Form No.
Form Name
Adult Day Services Center Questionnaire
none
ADSC Questionnaire Items
Data Retrieval Telephone Call Questionnaire
none
Data Retrieval Telephone Call
Residential Care Community Questionnaire
none
RCC Questionnaire Items
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
18,371
0
0
18,371
0
0
Annual Time Burden (Hours)
8,769
0
0
8,769
0
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
Yes
Burden Increase Due to:
Miscellaneous Actions
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
This is a new ICR.
Annual Cost to Federal Government:
$1,903,248
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]?
No
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
No
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
Shari Steinberg 404 639-4942 sxw2@cdc.gov
Common Form ICR:
No
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:
06/20/2012
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