Information Collection

Pilot Study of Proposed Nursing Home Survey on Resident Safety

IC 178948 under ICR 200703-0935-002 · OMB 0935-0132.

Documents and Forms

Document Name Document Type
Attachment B-NH Survey on Resident Safety 1-24-07.pdf Other-Questionnaire and instructions

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Pilot Study of Proposed Nursing Home Survey on Resident Safety	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 5 CFR 1320.5

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Questionnaire and instructions			Attachment B-NH Survey on Resident Safety 1-24-07.pdf		No	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,850	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,850	3,850
Annual IC Time Burden (Hours)	963	963
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.