Information Collection

Improving Quality of Care in Long-Term Care

IC 179905 under ICR 200704-0935-001 · OMB 0935-0133.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Form D Improving Quality of Care in Long-Term Care	Form
Form C Staff Interview Demo 2007 C_Staff InterviewDemo2007 07 31.pdf	Form
Form D Chart Abstract Demo 2007 D_Chart AbstractDemo2007 07 31.pdf	Form
Form B Resident Interview Demo 2007 B_ Resident InterviewDemo2007 07 31.pdf	Form

IC Title:

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form	Form D	Chart Abstract Demo 2007	D_Chart AbstractDemo2007 07 31.pdf	No	Printable Only
Form	Form C	Staff Interview Demo 2007	C_Staff InterviewDemo2007 07 31.pdf	No	Printable Only
Form	Form B	Resident Interview Demo 2007	B_ Resident InterviewDemo2007 07 31.pdf	No	Printable Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 354

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

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	354	354
Annual IC Time Burden (Hours)	590	590
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.