Information Collection

Improving Quality of Care in Long-Term Care

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

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Improving Quality of Care in Long-Term Care	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	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 %

	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

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.