OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Data Collection for the Residential Care Community and Adult Day Services Center Components of the National Study of Long-term Care Providers

ICR 201402-0920-003 · OMB 0920-0943 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Data Retrieval Telephone Call Questionnaire Form Modified Available
Adult Day Services Center Questionnaire Form Modified Repair queued
Residential Care Community Questionnaire Form Modified Available
2014 NSLTCP Supporting Statement-revised.doc Justification for No Material/Nonsubstantive Change Uploaded 2014-03-15 Available
Attachment C-7 Chain packet letters.doc Supplementary Document Uploaded 2014-01-31 Repair queued
Attachment C-6 Trouble Reaching You letters.docx Supplementary Document Uploaded 2014-01-31 Repair queued
Attachment C-5 Thank You Reminder letters.docx Supplementary Document Uploaded 2014-01-31 Repair queued
Attachment C-4 Follow up #2 letters.docx Supplementary Document Uploaded 2014-01-31 Repair queued
Attachment C-3 Follow-up #1 letters.docx Supplementary Document Uploaded 2014-01-31 Repair queued
Attachment C-2 First Mailing Letters.docx Supplementary Document Uploaded 2014-01-31 Available
Attachment C-1 Advance Notification letters.docx Supplementary Document Uploaded 2014-01-31 Repair queued
Attachment A-2 NSLTCP 2012 to 2014 RCC changes.xlsx Supplementary Document Uploaded 2014-01-31 Available
Attachment A-1 NSLTCP 2012 to 2014 ADSC changes.xlsx Supplementary Document Uploaded 2014-01-31 Available
2014 NSLTCP Supporting Statement 012314.doc Justification for No Material/Nonsubstantive Change Uploaded 2014-01-31 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
210276 RCC and ADSC Directors Follow-up Call Other-Phone Interview Questions New
202805 Data Retrieval Telephone Call Questionnaire Form Modified
202804 Adult Day Services Center Questionnaire Form Modified
202803 Residential Care Community Questionnaire Form Modified
ICR Details
0920-0943 201402-0920-003
Historical Active 201206-0920-004
HHS/CDC 21385
Data Collection for the Residential Care Community and Adult Day Services Center Components of the National Study of Long-term Care Providers
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 03/15/2014
Retrieve Notice of Action (NOA) 02/04/2014
  Inventory as of this Action Requested Previously Approved
07/31/2015 07/31/2015 07/31/2015
19,371 0 18,371
8,936 0 8,769
0 0 0
The National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention (CDC), seeks approval for a nonsubstantive change to an approved project (OMB No. 0920-0943 Exp. Date: 07/31/2015), data collection for the residential care community (RCC) and adult day services center (ADSC) components for the National Study of Long-Term Care Providers (NSLTCP), including the estimated sample size and estimated annual burden. As we did in 2012, the data to be collected from RCCs and ADSCs will include basic characteristics, services offered, staffing, and practices of providers, as well as distributions of the demographics, physical functioning, and cognitive functioning of users (RCC residents and ADSC participants) aggregated to the RCC/ADSC level. The 2014 NSLTCP will be administered by mail, web, and telephone. As we did in 2012, data will be collected from a sample of 11,690 RCCs and a census of 5,000 ADSCs in the 50 states and the District of Columbia.
US Code: 42 USC 242k Name of Law: Public Health Service Act
  
None
Not associated with rulemaking
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 19,371 18,371 0 1,000 0 0
Annual Time Burden (Hours) 8,936 8,769 0 167 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This change request provides questions for 2014 and adds a follow-up call which increases burden.
$1,903,248
Yes Part B of Supporting Statement
No
No
No
No
Uncollected
Carol Marsh 404 639-4773 [email protected]
  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.
02/04/2014