Frame Development for the National Survey of Long-Term Providers

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
NSLTCP Frame Supp State Part B 11-23.doc	Supporting Statement B	Uploaded 2011-12-08	Available
Attachment F-Thank You Letter 8-19.doc	Supplementary Document	Uploaded 2011-12-09	Available
Attachment A-NCHS Legislation 8-19.doc	Supplementary Document	Uploaded 2011-12-08	Available
Attachment C-Human Subjects 8-19.doc	Supplementary Document	Uploaded 2011-12-09	Available
Attachment D 4-Advance Package NCHS Confidentiality Brochure.doc	Supplementary Document	Uploaded 2011-12-09	Available
Attachment D 3-Advance Package Prof Assoc Letter.doc	Supplementary Document	Uploaded 2011-12-09	Available
Attachment D 2-Advance Package NCHS Cover Letter.doc	Supplementary Document	Uploaded 2011-12-09	Available
NSLTCP Frame Supp State Part A.doc	Supporting Statement A	Uploaded 2011-12-08	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
200463	Electronic File Development	Instruction	New
200462	Telephone Protocol	Instruction	New
200461	Contact Information Verification	Instruction	New

ICR Details

OMB Control No: 0920-0912	ICR Reference No: 201112-0920-008
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Frame Development for the National Survey of Long-Term Providers
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/12/2012
	Date Received in OIRA: 12/13/2011
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2013	12 Months From Approved
Responses	153	0	0
Time Burden (Hours)	132	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: NCHS seeks approval to collect data needed to develop an up-to-date sampling frame of residential care facilities. The frame will be used to draw a nationally representative sample for a planned survey, the National Survey of Long- Term Care Providers.

---

Authorizing Statute(s): US Code: 42 USC 242 Name of Law: USC
  

Citations for New Statutory Requirements: None

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 34996	06/15/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 76413	12/07/2011
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
Contact Information Verification
Telephone Protocol
Electronic File Development

---

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	153	0	0	153	0	0
Annual Time Burden (Hours)	132	0	0	132	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: No

Burden Reduction Due to:

Short Statement: This is a new information collection request.

---

Annual Cost to Federal Government: $429,816

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? Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

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

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

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: 12/13/2011

---