REPORT OF NURSING HOME CARE

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability

No forms / supporting documents in this ICR. Check IC Document Collections.

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
147347	REPORT OF NURSING HOME CARE	Form	Migrated

ICR Details

OMB Control No: 2900-0157	ICR Reference No: 198409-2900-009
Status: Historical Inactive	Previous ICR Reference No: 198308-2900-016
Agency/Subagency: VA	Agency Tracking No:
Title: REPORT OF NURSING HOME CARE
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Disapproved	Conclusion Date: 12/07/1984
	Date Received in OIRA: 09/10/1984
Terms of Clearance: NOT APPROVED. AS CONFIRMED BY VA OFFICIALS, THE JUSTIFICATION FOR THIS ACTIVITY MISSTATED THE USES MADE OF THE DATA COLLECTED. MOREOVER, VA HAS NOT PROVIDED ANY EVIDENCE THAT THERE IS A NEED TO CONTINUE TO REQUIRE FORM 10-1204B ON A MONTHLY BASIS FOR ALL PATIENTS IN COMMUNITY NURSING HOMES. IN VIEW OF THE ABOVE, THE FORM IS NO LONGER APPROVED FOR USE. ALL NURSING HOMES UNDER CONTRACT TO THE VA MUST BE INFORMED THAT THE FORM IS NO LONGER REQUIRED, AND A COPY OF THIS NOTIFIATION SHOULD BE SUBMITTED TO OMB WITHIN 90 DAYS OF THE DATE OF THIS OMB NOTICE.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		12/07/1984	09/30/1984
Responses	0	0	120,000
Time Burden (Hours)	0	0	20,000
Cost Burden (Dollars)	0	0	0

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Abstract: THE FORM IS NEEDED SO THAT NURSHING HOMES UNDER CONTRACT CAN REPORT ON THE CONTINUED RESIDENCY AND THE CONDITION OF EACH VA PATIENT. THE FORM PROVIDES THE VA WITH ONE INDICATION OF QUALITY AND TRIGGERS PAYME TO THE NURSING HOME.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
REPORT OF NURSING HOME CARE	10-1204B

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Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 09/10/1984

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