Information Collection

Nursing Home Administrators Survey

IC 205002 under ICR 201507-0920-011 · OMB 0920-0914.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0914 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0914 Nursing Home Administrators Survey	Form and Instruction
0920-0914 Attachment C1 Clean Copy C1 7-21-15.docx	Form and Instruction
Highlighted Copy C1 7-21-15.docx Attachment-C1- with changes	IC Document

IC Title:

Nursing Home Administrators Survey

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	0920-0914	Attachment C1	Clean Copy C1 7-21-15.docx		Yes	No	Fillable Printable

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 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	7	0	7
Annual IC Time Burden (Hours)	8	1	7
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment-C1- with changes	Highlighted Copy C1 7-21-15.docx	07/21/2015

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