Information Collection

LTC Resident Impact - state/local health depts.

IC 241492 under ICR 202004-0920-017 · OMB 0920-1290.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1290 can be found here:

Documents and Forms

Document Name Document Type
LTC Resident Impact - state/local health depts. Form
LTC Resident impact LTC_RESIDENT IMPACT and Facility Capacity 042320.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	LTC Resident Impact - state/local health depts.	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	LTC Resident impact	LTC_RESIDENT IMPACT and Facility Capacity 042320.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,446	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	63,596	63,596
Annual IC Time Burden (Hours)	21,199	21,199
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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