Information Collection

Interviews for the National Study of Long-term Care Providers Gaps Project

IC 222776 under ICR 201407-0920-008 · OMB 0920-1030.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1030 can be found here:

Documents and Forms

Document Name Document Type
Interviews for the National Study of Long-term Care Providers Gaps Project Form and Instruction
Attachment D-1-Interview for Researchers and Association Representatives_071916.docx Other-Interview script
Attachment D-2-Interview for State Agency Staff_071916.docx Other-Interview script
Scheduling script Attachment C-1 Scheduling Script A_071916.doc Form and Instruction
Scheduling script B Attachment C-2 Scheduling Script B_071916.doc Form and Instruction
Gaps Project SSA_072716.doc Supporting Statement A IC Document
Gaps Project SSB_072716.doc Supporting Statement B IC Document
Attachment A-Non Human Subjects Research Determination.pdf Research determination IC Document
Attachment B-Introductory email_071916.doc Introductory email IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Interviews for the National Study of Long-term Care Providers Gaps Project	Agency IC Tracking Number:	16AWG

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	none	Scheduling script	Attachment C-1 Scheduling Script A_071916.doc	Yes	No	Paper Only
Form and Instruction	none	Scheduling script B	Attachment C-2 Scheduling Script B_071916.doc	Yes	No	Paper Only
Other-Interview script			Attachment D-1-Interview for Researchers and Association Representatives_071916.docx	Yes	No	Paper Only
Other-Interview script			Attachment D-2-Interview for State Agency Staff_071916.docx	Yes	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Health Resources Utilization Statistics	FR Citation: 49 FR 37697

Number of Respondents: 36	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	36	36
Annual IC Time Burden (Hours)	20	20
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement A	Gaps Project SSA_072716.doc	08/01/2016
Supporting Statement B	Gaps Project SSB_072716.doc	08/01/2016
Research determination	Attachment A-Non Human Subjects Research Determination.pdf	08/01/2016
Introductory email	Attachment B-Introductory email_071916.doc	08/01/2016

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.