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OMB Control No: 0985-0069	ICR Reference No: 202008-0985-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/ACL	Agency Tracking No:
Title: Outcome Evaluation of the Long-Term Care Ombudsman Program (LTCOP)
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: 09/17/2020
	Date Received in OIRA: 08/05/2020
Terms of Clearance: Approved consistent with updated plans for data collection in light of the COVID-19 public health emergency.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2023	36 Months From Approved
Responses	1,985	0	0
Time Burden (Hours)	715	0	0
Cost Burden (Dollars)	0	0	0

Abstract: The primary goals of ACL’s/AoA’s Outcome Evaluation and Special Studies Related to the Long-Term Care Ombudsman Program (LTCOP) are to (1) understand the extent to which LTCOP services have been carried out effectively at the state and local levels and (2) document outcomes of LTCOP activities at the individual (residents) and systems (long-term care practices, programs, and policies) levels. To achieve these goals, data collection will be required from long-term care residents/family members, facility staff, facility administrators, coordinating entities, and LTCOP staff. By obtaining data through a mix of focus groups, surveys, and interviews, these key respondent groups will provide the necessary information to better understand and document the program’s processes and outcomes. The purpose of the outcome evaluation is to understand and document the LTCOP’s effectiveness at the state and local levels and outcomes at the individual and systems levels. Throughout the evaluation, an additional aim is to obtain stakeholder buy-in, feedback on, and participation in the study. ACL/AoA anticipates that this study will: provide practical and policy-relevant insight into LTCOP services and processes; highlight promising program practices; and ultimately, provide critical information to enable ACL/AoA to better protect greater numbers of vulnerable elders. Data collection for the outcome evaluation will involve site visits to four State Long-Term Care Ombudsman Programs (SLTCOPs). During these visits, focus groups will be conducted with residents, family members, and facility staff. In addition, interviews will be conducted with stakeholders/representatives of entities with which the Ombudsman program coordinates. For each participating state, a survey will be administered in nursing home and board and care home facility administrators. The goal of focus groups with residents, family members, and facility staff is to assess their understanding of the Ombudsman program’s role, their interactions with Ombudsmen, program strengths and challenges, and areas for further support. Interviews with representative of entities with which Ombudsmen coordinate focus on understanding their relationship with the program, the extent of coordination, benefits and challenges of coordination, programs strengths, and areas for improvement. In each participating state, a survey will be administered to a random sample of facility administrators. Topics covered will include Ombudsman activities with facility staff and residents, impact on facility practices, and facility characteristics.

Authorizing Statute(s): PL: Pub.L. 116 - 131 127 Name of Law: Title I,The Supporting Older Americans Act of 2020

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:
	85 FR 20506	04/13/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 46124	07/31/2020
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
Focus Group-Facility Administrators and Staff	NA, NA	,
Focus Group-Residents and Family	NA
Stakeholders/ State Unit on Aging (SUA) Directors/Former Ombudsmen	NA, NA, NA	, ,

ICR Summary of Burden

	Total Approved	Change Due to Agency Discretion
Annual Number of Responses	1,985	1,985
Annual Time Burden (Hours)	715	715
Annual Cost Burden (Dollars)	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 information collection request; there is a program change increase of 1,985 annual burden hours and 715 annual respondents.

Annual Cost to Federal Government: $293,000

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. 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? No

Agency Contact: Tomakie Washington 202 795-7336 tomakie.washington@acl.hhs.gov

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