Information Collection

Understanding How Families Access and Use Long-Term Care Services

IC 221448 under ICR 201403-0990-004 · OMB 0990-0421.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0421 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment A Draft FG Discusion Guide.docx	Other-survey
Attachment B Recruitment Screener.docx	Other-screener
SSA_Longtermcare Focus Groups_minus remuneration.docx Support statement A	IC Document
SSB_Longtermcare Focus Groups.docx Suppt st. B	IC Document
LTC Focus Groups_Cover Sheet_0990-0421.doc cover memo	IC Document

IC Title:

Understanding How Families Access and Use Long-Term Care Services

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-screener			Attachment B Recruitment Screener.docx		No		Paper Only
Other-survey			Attachment A Draft FG Discusion Guide.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 40

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	40	40
Annual IC Time Burden (Hours)	80	80
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Support statement A	SSA_Longtermcare Focus Groups_minus remuneration.docx	05/10/2016
Suppt st. B	SSB_Longtermcare Focus Groups.docx	05/10/2016
cover memo	LTC Focus Groups_Cover Sheet_0990-0421.doc	05/10/2016

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.