Long-Term Care Awareness Campaign Demonstration Project

ICR 200509-0938-012

OMB: 0938-0847

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
0938-0847 200509-0938-012
Historical Active 200301-0938-010
HHS/CMS
Long-Term Care Awareness Campaign Demonstration Project
Reinstatement with change of a previously approved collection   No
Emergency 10/03/2005
Approved without change 10/21/2005
Retrieve Notice of Action (NOA) 09/19/2005
  Inventory as of this Action Requested Previously Approved
03/31/2006 03/31/2006
4,500 0 0
1,350 0 0
0 0 0

Data will be collected to pilot test a national campaign to educate current and future Medicare beneficiaries and their families about long-term health care needs. Project findings will be used to design and implement a nationwide campaign. Respondents will be from ages 50-70.

None
None


No

1
IC Title Form No. Form Name
Long-Term Care Awareness Campaign Demonstration Project CMS-10041

  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 4,500 0 0 4,500 0 0
Annual Time Burden (Hours) 1,350 0 0 1,350 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
No

$0
Yes Part B of Supporting Statement
No
Uncollected
Uncollected
Uncollected
Uncollected

  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.
09/19/2005


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