Electronic File Development

Attachment G: Electronic File Development

Form Approved

OMB No. XXXX-XXXX

Exp. Date __xx/xx/20xx

NOTICE – Public reporting burden of this collection of information is estimated to average 2 hours per response. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road, MS D-74, Atlanta, GA 30333, ATTN: PRA (XXXX-XXXX).

Assurance of Confidentiality – All information which would permit identification of an individual, a practice, or an establishment will be held confidential, will be used for statistical purposes only by NCHS staff, contractors, and agents only when required and with necessary controls, and will not be disclosed or released to other persons without the consent of the individual or establishment in accordance with section 308(d) of the Public Health Service Act (42 USC 242m) and the Confidential Information Protection and Statistical Efficiency Act (PL-107-347).

Respondents will develop an electronic listing of the licensed residential care facilities (preferably in Excel format) for which the agency is responsible, if such files with the needed variables are not downloadable from the state’s website.

Formats other than Excel can be negotiated on a case-by-cases basis, if an individual state cannot provide its file in Excel or doing so would be too burdensome on the state.

Encrypted files will be sent to NCHS via mail and electronically through a secure password-protected website to ensure the confidentiality of the data.

We will provide states with the specifications on what variables we need in the files. Variables needed include the name, address, phone number, and website (if available) of the residential care facility; name, phone number, and email address (if available) of facility director; licensure category; chain affiliation; ownership type; and bed size.

We expect this to take on average 2 hours.