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:
0920-0943
ICR Reference No:
201803-0920-001
Status:
Historical Active
Previous ICR Reference No:
201604-0920-007
Agency/Subagency:
HHS/CDC
Agency Tracking No:
0920-0943
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:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
05/10/2018
Retrieve Notice of Action (NOA)
Date Received in OIRA:
04/11/2018
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
12/31/2019
12 Months From Approved
05/31/2019
Responses
13,496
0
8,974
Time Burden (Hours)
4,256
0
4,310
Cost Burden (Dollars)
0
0
0
Abstract:
This request is for a Revision of OMB Control Number 0920-0943 - Data Collection for the Residential Care Community and Adult Day Services Center Components of the National Study of Long-term Care Providers. The goal of this study is to collect data for the residential care community (RCC) and adult day services center (ADSC) survey components of the 4th National Study of Long-Term Care Providers (NSLTCP). The data to be collected will include the basic characteristics, services, staffing, and practices of RCCs and ADSCs, and the demographics, selected health conditions and health care utilization, physical functioning, and cognitive functioning of RCC residents and ADSC participants. This Revision results in an overall net reduction of Burden Hours, due to the elimination of a former data retrieval call that was previously included to allow for errors or omissions in returned surveys that required a call to reach back out to the Directors or their designated staff member. The 2018 NSLTCP includes the introduction of a services user questionnaire which was not part of the previous submission.
Authorizing Statute(s):
US Code:
42 USC 242k
Name of Law: Public Health Service Act
Citations for New Statutory Requirements:
None
EO 14192 Designation:
Deregulatory
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:
82 FR 60198
12/19/2017
30-day Notice:
Federal Register Citation:
Citation Date:
83 FR 14857
04/06/2018
Did the Agency receive public comments on this ICR?
Yes
Number of Information Collection (IC) in this ICR:
5
IC Title
Form No.
Form Name
2016 Adult Day Services Center Questionnaire-Version B
NONE
National Study of Long-Term Care Providers--2016 Adult Day Services Center Questions-Version B
2016 Adult Day Services Center Questions-Version A
NONE
National Study of Long-Term Care Providers--2016 Adult Day Services Center Questions-Version A
2016 Residential Care Community Questions-Version A
NONE
National Study of Long Term Care Providers--2016 Residential Care Community Questions-Version A
2016 Residential Care Community Questions-Version B
NONE
National Study of Long Term Care Provider --2016 Residential Care Community Questions-Version B
ADSC Provider Questionnaire
0920-0943
ADSC Provider Questionnaire
Data Retrieval Telephone Call
RCC Provider Questionnaire
0920-0943
RCC Provider Questionnaire
RCC/ADSC Contact Confirmation Call Script
0920-0943
RCC/ADSC Contact Confirmation Call Script
RCC/ADSC Sampling and Services User Questionnaire
0920-0943
RCC/ADSC Sampling and Services User Questionnaire
RCC/ADSC Screener and Appointment Setting Call Script
0920-0943
RCC/ADSC Screener and Appointment Setting Call Script
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
13,496
8,974
0
4,522
0
0
Annual Time Burden (Hours)
4,256
4,310
0
-54
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:
Yes
Burden Reduction Due to:
Miscellaneous Actions
Short Statement:
Submission of 0920-0942 is a request for Revision. This Revision results in an overall net reduction of Burden Hours, due to the elimination of a data retrieval call, and includes the introduction of a services user questionnaire which was not part of the previous submission.
Annual Cost to Federal Government:
$2,355,222
Does this IC contain surveys, censuses, or employ statistical methods?
Yes
Part B of Supporting Statement
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.
Yes
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.
Yes
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:
Jeffrey Zirger 404 639-7118 wtj5@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:
04/11/2018
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