View Information Collection Request (ICR) Package
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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:
0985-0005
ICR Reference No:
201802-0985-003
Status:
Historical Active
Previous ICR Reference No:
201612-0985-001
Agency/Subagency:
HHS/ACL
Agency Tracking No:
Title:
State Annual Long-Term Care Ombudsman Report
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved with change
Conclusion Date:
04/10/2018
Retrieve Notice of Action (NOA)
Date Received in OIRA:
02/27/2018
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
04/30/2021
36 Months From Approved
02/29/2020
Responses
52
0
52
Time Burden (Hours)
11,628
0
7,754
Cost Burden (Dollars)
0
0
0
Abstract:
The State Annual Long Term Care Ombudsman Report is needed to: comply with state and Administration on Aging reporting requirements in the Older Americans Act; carry out recommendations made by the General Accounting Office, the Department of Health and Human Services' Office of the Inspector General, and the Institute of Medicine; advocate at the state and federal levels for changes needed to improve the quality of life and care in long-term care facilities; and effectively manage the Long-Term Care Ombudsman Program at the local, state and federal levels. The report form and instructions have been in continuous use, with minor modifications, since they were first approved by OMB for the FY 1995 reporting period.
Authorizing Statute(s):
US Code:
42 USC chapter 35
Name of Law: Programs for Older Americans
PL:
Pub.L. 109 - 365 712 (c),(h)(1)-(3)
Name of Law: Older Americans 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:
81 FR 52438
08/08/2016
30-day Notice:
Federal Register Citation:
Citation Date:
83 FR 8086
02/23/2018
Did the Agency receive public comments on this ICR?
Yes
Number of Information Collection (IC) in this ICR:
1
IC Title
Form No.
Form Name
State Annual Long-Term Care Ombudsman Report
3, 1, 2, 3
NORS Table 3 Program Information
,
NORS Table 1
,
Table 2 Complaint Codes
,
NORS Table 3 Program Information
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
52
52
0
0
0
0
Annual Time Burden (Hours)
11,628
7,754
0
3,874
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:
The Administration for Community Living (ACL) proposes to revise the existing data in order to: (1) simplify the form and clarify the instructions by reducing the number of data codes currently collected and to employ modern methodologies for data submission, which are efficient, effective, and improve data quality. This data collection will also support ACL in tracking performance outcomes and efficiency measures with respect to the annual and long-term performance targets established in compliance with the Government Performance Results Modernization Act (GPRMA).
Annual Cost to Federal Government:
$403,712
Does this IC contain surveys, censuses, or employ statistical methods?
No
Does this ICR request any personally identifiable information (see
OMB Circular No. A-130
for an explanation of this term)? Please consult with your agency's privacy program when making this determination.
No
Does this ICR include a form that requires a Privacy Act Statement (see
5 U.S.C. §552a(e)(3)
)? Please consult with your agency's privacy program when making this determination.
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:
Caldwell Jackson 202 357-3580 caldwell.jackson@acl.hhs.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:
02/27/2018
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