Information Collection

Attachment D: Interview Protocol for Long Term Care Settings

IC 213435 under ICR 201410-0935-001 · OMB 0935-0225.

Documents and Forms

Document Name Document Type
Attachment D HAI NAP II Interview Protcol for LTC.docx Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Attachment D: Interview Protocol for Long Term Care Settings	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
Instruction			Attachment D HAI NAP II Interview Protcol for LTC.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 8	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	8	8
Annual IC Time Burden (Hours)	8	8
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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