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:
202007-0920-018
Status:
Historical Active
Previous ICR Reference No:
201803-0920-001
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:
Reinstatement with change of a previously approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
09/03/2020
Retrieve Notice of Action (NOA)
Date Received in OIRA:
07/28/2020
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
09/30/2023
24 Months From Approved
Responses
8,978
0
0
Time Burden (Hours)
4,311
0
0
Cost Burden (Dollars)
0
0
0
Abstract:
This request is for a Reinstatement with change 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 reinstatement involves minor changes to the instruments including addition of COVID-19 questions. The number of respondents and the burden have increased as well.
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:
84 FR 57431
10/25/2019
30-day Notice:
Federal Register Citation:
Citation Date:
85 FR 45433
07/28/2020
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
ADSC Provider Questionnaire
0920-0943
ADSC Provider Questionnaire
Data Retrieval
0920-0943
Data Retrieval
RCC Provider Questionnaire
0920-0943
RCC 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
8,978
0
0
8,978
-10,488
10,488
Annual Time Burden (Hours)
4,311
0
0
4,311
-2,751
2,751
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 burden increase is due to the increase in respondents.
Annual Cost to Federal Government:
$1,410,970
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?
Yes
Agency Contact:
Kevin Joyce 404 639-1944 kdj7@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:
07/28/2020
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