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Federal forms, ICRs, and supporting documents

Information Collection

National Study of Long-Term Care Providers Feasibility Project to Collect Person-Level Data from Residential Care Communities and Adult Day Services Centers

IC 220406 under ICR 201407-0920-008 · OMB 0920-1030.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

National Study of Long-Term Care Providers Feasibility Project to Collect Person-Level Data from Residential Care Communities and Adult Day Services Centers 16ST
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-1030 Attachment C Second call script-sampling interview and probing Attachment B First call script--screening 030116.docx Yes Yes Fillable Printable
Form and Instruction 0920-1030 Attachment C Second call script-sampling interview and probing Attachment C Second call script-sampling interview and probing 030116.docx Yes Yes Fillable Printable

Health Public Health Monitoring

Health Resources Utiliztion Statistics  49 FR 37697

90 0
   
Private Sector Businesses or other for-profits
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 90 0 90 0 0 0
Annual IC Time Burden (Hours) 91 0 91 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
NSLTCP Feasibility Project SSA NSLTCP Feasibility Project SSA 022916.doc 03/02/2016
NSLTCP Feasibility Project SSB NSLTCP Feasibility Project SSB 022916.doc 03/02/2016
Attachment A ERB Approval Letter Attachment A ERB Approval Letter 1-8-16.docx 03/02/2016
Attachment D-1 Advance Package Attachment D-1 Advance Package 1-19-16.docx 03/02/2016
Attachment D-2 Pre-Appointment Package Attachment D-2 Pre-Appointment Package 1-7-16.docx 03/02/2016
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.