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 201803-0920-001 · OMB 0920-0943 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form 0920-0943 RCC/ADSC Sampling and Services User Questionnaire Form and Instruction New Repair queued
Form 0920-0943 ADSC Provider Questionnaire Form and Instruction New Repair queued
Form 0920-0943 RCC Provider Questionnaire Form and Instruction New Available
Form 0920-0943 RCC/ADSC Screener and Appointment Setting Call Script Form New Available
Form 0920-0943 RCC/ADSC Contact Confirmation Call Script Form New Available
2016 Adult Day Services Center Questionnaire-Version B Form Removed Available
2016 Adult Day Services Center Questions-Version A Form Removed Available
2016 Residential Care Community Questions-Version B Form Removed Repair queued
2016 Residential Care Community Questions-Version A Form Removed Repair queued
Attachment J Services User CATI Confirmation and Prep Email or Mail Text 11-28-17.doc Supplementary Document Uploaded 2018-04-10 Repair queued
Attachment I-3 Provider Questionnaire Thank you Email or Mail_11-28-17.doc Supplementary Document Uploaded 2018-04-10 Repair queued
Attachment I-2 010518.docx Supplementary Document Uploaded 2018-04-10 Available
Attachment I-1 First Provider Questionnaire Email or Mail Text _11-28-17.docx Supplementary Document Uploaded 2018-04-10 Repair queued
Attachment G-5 Advance Package NCHS Strictly Confidential Brochure 11-28-17.docx Supplementary Document Uploaded 2018-04-10 Repair queued
Attachment G-4 Advance Package ERB Approval Letter 11-28-17.docx Supplementary Document Uploaded 2018-04-10 Available
Attachment G-3 Advance Package Letters of Support_11-28-17.docx Supplementary Document Uploaded 2018-04-10 Available
Attachment G-2 Advance Package Resident and Participant NCHS Data Briefs_11-28-17.docx Supplementary Document Uploaded 2018-04-10 Repair queued
Attachment G-1 Advance Package-NCHS Cover Letter with FAQs 11-28-17.docx Supplementary Document Uploaded 2018-04-10 Repair queued
Attachment E Protocol Flow Chart_11-28-17.docx Supplementary Document Uploaded 2018-04-10 Available
Attachment D External Expert Reviewers 011618.docx Supplementary Document Uploaded 2018-04-10 Repair queued
Attachment A Public Health Service Act (306ab and 308d)_11-28-17.docx Supplementary Document Uploaded 2018-04-10 Available
2018 Supp Statement B 10APR2018.docx Supporting Statement B Uploaded 2018-04-10 Available
2018 Supp Statement A 10APR2018.doc Supporting Statement A Uploaded 2018-04-10 Available
Attachment B2 Public Comments.docx Supplementary Document Uploaded 2018-04-09 Repair queued
Attachment B1 Sixty-day Notice 011618.pdf Supplementary Document Uploaded 2018-04-09 Repair queued
ICR Details
0920-0943 201803-0920-001
Historical Active 201604-0920-007
HHS/CDC 0920-0943
Data Collection for the Residential Care Community and Adult Day Services Center Components of the National Study of Long-term Care Providers
Revision of a currently approved collection   No
Regular
Approved without change 05/10/2018
Retrieve Notice of Action (NOA) 04/11/2018
  Inventory as of this Action Requested Previously Approved
12/31/2019 12 Months From Approved 05/31/2019
13,496 0 8,974
4,256 0 4,310
0 0 0

This request is for a Revision of OMB Control Number 0920-0943 - Data Collection for the Residential Care Community and Adult Day Services Center Components of the National Study of Long-term Care Providers. The goal of this study is to collect data for the residential care community (RCC) and adult day services center (ADSC) survey components of the 4th National Study of Long-Term Care Providers (NSLTCP). The data to be collected will include the basic characteristics, services, staffing, and practices of RCCs and ADSCs, and the demographics, selected health conditions and health care utilization, physical functioning, and cognitive functioning of RCC residents and ADSC participants. This Revision results in an overall net reduction of Burden Hours, due to the elimination of a former data retrieval call that was previously included to allow for errors or omissions in returned surveys that required a call to reach back out to the Directors or their designated staff member. The 2018 NSLTCP includes the introduction of a services user questionnaire which was not part of the previous submission.

US Code: 42 USC 242k Name of Law: Public Health Service Act
  
None

Deregulatory

Not associated with rulemaking

  82 FR 60198 12/19/2017
83 FR 14857 04/06/2018
Yes

  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 13,496 8,974 0 4,522 0 0
Annual Time Burden (Hours) 4,256 4,310 0 -54 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
Yes
Miscellaneous Actions
Submission of 0920-0942 is a request for Revision. This Revision results in an overall net reduction of Burden Hours, due to the elimination of a data retrieval call, and includes the introduction of a services user questionnaire which was not part of the previous submission.

$2,355,222
Yes Part B of Supporting Statement
    Yes
    Yes
No
No
No
Uncollected
Jeffrey Zirger 404 639-7118 [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.
04/11/2018