OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

National Survey of Residential Care Facilities (NSRCF) 2008-2010

ICR 200911-0920-003 · OMB 0920-0780 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form 8 Line 8 National Survey Resident Questionnaire Form and Instruction Removed Available
Form 7 Line 7 National Survey Facility Questionnaire Form and Instruction Removed Available
OMB Supp State Part B.doc Supporting Statement B Uploaded 2009-10-20 Available
Attachment E-ERB Approval.doc Supplementary Document Uploaded 2009-10-20 Repair queued
Attachment D-Questionnaire Reviewers.doc Supplementary Document Uploaded 2009-10-20 Available
Attachment C-Technical Experts.doc Supplementary Document Uploaded 2009-10-20 Available
Attachment B-Federal Register Notice.doc Supplementary Document Uploaded 2009-10-20 Available
Attachment A-NCHS Legislation.doc Supplementary Document Uploaded 2009-10-20 Available
Attachment M-Refusal Conversion Letters.doc Supplementary Document Uploaded 2009-10-21 Available
Attachment L-Thank You Letters.doc Supplementary Document Uploaded 2009-10-21 Repair queued
Attachment F-Advance Package.doc Supplementary Document Uploaded 2009-10-20 Available
OMB_Supp_State_Part_A.doc Supporting Statement A Uploaded 2009-10-27 Available
IC Document Collections
IC IDCollectionTypeStatusForm
183894 Line 8 National Survey Resident Questionnaire Form and Instruction Removed
183893 Line 7 National Survey Facility Questionnaire Form and Instruction Removed
183892 NSRCF - Verification Form Other-WORD Modified
183891 NSRCF - Resident Questionnaire Other-WORD Modified
183890 NSRCF - Faciility Questionnaire Other-WORD Modified
183889 NSRCF - Pre-Interview Worksheet Other-WORD Modified
183888 NSRCF - Resident Selection Questionnaire Other-WORD Modified
183887 NSRCF - Facility Screener Questionnaire Other-WORD Modified
ICR Details
0920-0780 200911-0920-003
Historical Active 200802-0920-012
HHS/CDC
National Survey of Residential Care Facilities (NSRCF) 2008-2010
Revision of a currently approved collection   No
Regular
Approved without change 12/14/2009
Retrieve Notice of Action (NOA) 11/04/2009
Prior terms of clearance were met.
  Inventory as of this Action Requested Previously Approved
12/31/2012 01/31/2012 12/31/2009
9,113 0 6,200
3,572 0 2,778
0 0 0
The National Survey of Residential Care Facilities will produce national estimates on the numbers of residential care facilities in the US and the number of residents receiving care. It will provide estimates on the characteristics of both the facilities and the residents.
US Code: 42 USC 242k Name of Law: National Center for Health Statistics
  
None
Not associated with rulemaking
  74 FR 27324 06/09/2009
74 FR 53260 10/16/2009
No
  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 9,113 6,200 0 2,913 0 0
Annual Time Burden (Hours) 3,572 2,778 0 794 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
Yes
Changing Forms
This information collection was previously approved for pretesting only and was successfully completed. The estimated annual burden has changed from 2,778 hours to 3,572 hours, an increase of 794 hours. The current annualized burden estimates are just for the national survey, since the pretest has already been completed. The national survey has a higher burden because the facility questionnaire in the pretest took longer than expected, by 35 minutes on average. The annualized burden also now covers a two year period rather than a three year period.
$3,067,092
Yes Part B of Supporting Statement
No
Uncollected
Uncollected
No
Uncollected
Thelma Sims 4046394771
  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
11/04/2009