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

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 8 Line 8 National Survey Resident Questionnaire	Form and Instruction	Removed	Available
Form 7 Line 7 National Survey Facility Questionnaire	Form and Instruction	Removed	Available
OMB Supp State Part B.doc	Supporting Statement B	Uploaded 2009-10-20	Available
Attachment E-ERB Approval.doc	Supplementary Document	Uploaded 2009-10-20	Available
Attachment D-Questionnaire Reviewers.doc	Supplementary Document	Uploaded 2009-10-20	Available
Attachment C-Technical Experts.doc	Supplementary Document	Uploaded 2009-10-20	Available
Attachment B-Federal Register Notice.doc	Supplementary Document	Uploaded 2009-10-20	Available
Attachment A-NCHS Legislation.doc	Supplementary Document	Uploaded 2009-10-20	Available
Attachment M-Refusal Conversion Letters.doc	Supplementary Document	Uploaded 2009-10-21	Available
Attachment L-Thank You Letters.doc	Supplementary Document	Uploaded 2009-10-21	Available
Attachment F-Advance Package.doc	Supplementary Document	Uploaded 2009-10-20	Available
OMB_Supp_State_Part_A.doc	Supporting Statement A	Uploaded 2009-10-27	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
183894	Line 8 National Survey Resident Questionnaire	Form and Instruction	Removed
183893	Line 7 National Survey Facility Questionnaire	Form and Instruction	Removed
183892	NSRCF - Verification Form	Other-WORD	Modified
183891	NSRCF - Resident Questionnaire	Other-WORD	Modified
183890	NSRCF - Faciility Questionnaire	Other-WORD	Modified
183889	NSRCF - Pre-Interview Worksheet	Other-WORD	Modified
183888	NSRCF - Resident Selection Questionnaire	Other-WORD	Modified
183887	NSRCF - Facility Screener Questionnaire	Other-WORD	Modified

ICR Details

OMB Control No: 0920-0780	ICR Reference No: 200911-0920-003
Status: Historical Active	Previous ICR Reference No: 200802-0920-012
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: National Survey of Residential Care Facilities (NSRCF) 2008-2010
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/14/2009
	Date Received in OIRA: 11/04/2009
Terms of Clearance: Prior terms of clearance were met.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2012	01/31/2012	12/31/2009
Responses	9,113	0	6,200
Time Burden (Hours)	3,572	0	2,778
Cost Burden (Dollars)	0	0	0

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Abstract: The National Survey of Residential Care Facilities will produce national estimates on the numbers of residential care facilities in the US and the number of residents receiving care. It will provide estimates on the characteristics of both the facilities and the residents.

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Authorizing Statute(s): US Code: 42 USC 242k Name of Law: National Center for Health Statistics
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 27324	06/09/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 53260	10/16/2009
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 6

table that charts list of burden

IC Title	Form No.	Form Name
NSRCF - Faciility Questionnaire
NSRCF - Resident Questionnaire
NSRCF - Verification Form
Line 7 National Survey Facility Questionnaire	7	National Survey Facility Questionnaire
Line 8 National Survey Resident Questionnaire	8	National Survey Resident Questionnaire
NSRCF - Facility Screener Questionnaire
NSRCF - Resident Selection Questionnaire
NSRCF - Pre-Interview Worksheet

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ICR Summary of Burden

table that charts list of burden

	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	9,113	6,200	0	2,913	0	0
Annual Time Burden (Hours)	3,572	2,778	0	794	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Changing Forms

Short Statement: This information collection was previously approved for pretesting only and was successfully completed. The estimated annual burden has changed from 2,778 hours to 3,572 hours, an increase of 794 hours. The current annualized burden estimates are just for the national survey, since the pretest has already been completed. The national survey has a higher burden because the facility questionnaire in the pretest took longer than expected, by 35 minutes on average. The annualized burden also now covers a two year period rather than a three year period.

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Annual Cost to Federal Government: $3,067,092

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 11/04/2009

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