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Nursing Home Administrators Committee Chair Interview
Workplace Violence Prevention Programs In New Jersey Healthcare Facilities
OMB: 0920-0914
IC ID: 205003
OMB.report
HHS/CDC
OMB 0920-0914
ICR 201212-0920-001
IC 205003
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0914 can be found here:
2018-09-11 - No material or nonsubstantive change to a currently approved collection
2018-03-28 - Extension without change of a currently approved collection
Documents and Forms
Document Name
Document Type
Appendix C2.docx
Other-Interview
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Nursing Home Administrators Committee Chair Interview
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
New
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Other-Interview
Appendix C2.docx
Yes
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
7
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
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
7
0
7
0
0
0
Annual IC Time Burden (Hours)
7
0
7
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.