Information Collection

National Study of Long-Term Care Providers Feasibility Project to Collect Person-Level Data from Residential Care Communities and Adult Day Services Centers

IC 220406 under ICR 201407-0920-008 · OMB 0920-1030.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1030 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1030 National Study of Long-Term Care Providers Feasibility Project to Collect Person-Level Data from Residential Care Communities and Adult Day Services Centers	Form and Instruction
0920-1030 Attachment C Second call script-sampling interview and p Attachment B First call script--screening 030116.docx	Form and Instruction
0920-1030 Attachment C Second call script-sampling interview and p Attachment C Second call script-sampling interview and probing 030116.docx	Form and Instruction
NSLTCP Feasibility Project SSA 022916.doc NSLTCP Feasibility Project SSA	IC Document
NSLTCP Feasibility Project SSB 022916.doc NSLTCP Feasibility Project SSB	IC Document
Attachment A ERB Approval Letter 1-8-16.docx Attachment A ERB Approval Letter	IC Document
Attachment D-1 Advance Package 1-19-16.docx Attachment D-1 Advance Package	IC Document
Attachment D-2 Pre-Appointment Package 1-7-16.docx Attachment D-2 Pre-Appointment Package	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

National Study of Long-Term Care Providers Feasibility Project to Collect Person-Level Data from Residential Care Communities and Adult Day Services Centers

Agency IC Tracking Number:

16ST

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
Form and Instruction	0920-1030	Attachment C Second call script-sampling interview and probing	Attachment B First call script--screening 030116.docx		Yes	Yes	Fillable Printable
Form and Instruction	0920-1030	Attachment C Second call script-sampling interview and probing	Attachment C Second call script-sampling interview and probing 030116.docx		Yes	Yes	Fillable Printable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Health Resources Utiliztion Statistics

FR Citation: 49 FR 37697

Number of Respondents: 90

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

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	90	90
Annual IC Time Burden (Hours)	91	91
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
NSLTCP Feasibility Project SSA	NSLTCP Feasibility Project SSA 022916.doc	03/02/2016
NSLTCP Feasibility Project SSB	NSLTCP Feasibility Project SSB 022916.doc	03/02/2016
Attachment A ERB Approval Letter	Attachment A ERB Approval Letter 1-8-16.docx	03/02/2016
Attachment D-1 Advance Package	Attachment D-1 Advance Package 1-19-16.docx	03/02/2016
Attachment D-2 Pre-Appointment Package	Attachment D-2 Pre-Appointment Package 1-7-16.docx	03/02/2016

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