Information Collection

Long-term Care Survey (survey Of Impaired Individuals In Households)

IC 116567 under ICR 198112-0990-001 · OMB 0990-0077.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type

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IC Title:

LONG-TERM CARE SURVEY (SURVEY OF IMPAIRED INDIVIDUALS IN HOUSEHOLDS)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Migrated

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	OS-25-81				No	No

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 57,500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	57,500	57,500
Annual IC Time Burden (Hours)	10,383	10,383
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded

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