Data Retrieval Telephone Call

Attachment I: Data Retrieval Telephone Call

Form Approved

OMB No. XXXX-XXXX

Exp. Date __xx/xx/20xx

NOTICE – Public reporting burden of this collection of information is estimated to average 15 minutes 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).

There will be data retrieval calls to RCC and ADSC directors when after receiving the questionnaires there is missing information for critical staffing and resident/participant items, such as the number of full-time and part-time/ Full-Time Equivalent Registered Nurses and race/ethnicity distributions of users aggregated to the provider level approximately in returned mail or web surveys.

In terms of respondent burden, we have assumed that the respondent will spend on average 15 minutes on the phone during the retrieval call, and that no more than 10% of cases will require retrieval.