Information Collection

Nursing Home Administrators Survey

IC 205002 under ICR 201510-0920-006 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Nursing Home Administrators Survey	Form
Evaluation of Nursing Home Workplace Violence Prevention C1. Abstraction Form.docx101915.docx	Form

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	none	Evaluation of Nursing Home Workplace Violence Prevention Program Abstraction Form	C1. Abstraction Form.docx101915.docx		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 20

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	20	13	7
Annual IC Time Burden (Hours)	20	13	7
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.