Line 1 Pretest Facility Screener

National Survey of Residential Care Facilities (NSRCF) 2008-2010

OMB: 0920-0780

IC ID: 183888

Information Collection (IC) Details

View Information Collection (IC)

Line 1 Pretest Facility Screener
 
Yes New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 1 Pretest Facility Screener OMB Attachment F-Pretest Facility Screener_061108.doc Yes Yes Fillable Printable

Health Public Health Monitoring

Health Resources Utilization Statistics  49 FR 37697

25 10
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 25 0 25 0 0 0
Annual IC Time Burden (Hours) 4 0 4 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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