Data Collection for the Residential Care Community and Adult Day Services Center Components of the National Study of Long-term Care Providers

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
2016 Adult Day Services Center Questionnaire-Version B	Form	Modified	Repair queued
2016 Adult Day Services Center Questions-Version A	Form	Modified	Repair queued
2016 Residential Care Community Questions-Version B	Form	Modified	Available
2016 Residential Care Community Questions-Version A	Form	Modified	Repair queued
NSLTCP response rates by year, facility type, and mode 2012 and 2014.pptx	Supplementary Document	Uploaded 2016-05-26	Available
Att G_Human Subjects Determination.doc	Supplementary Document	Uploaded 2016-04-25	Repair queued
Att B-Federal Register Notice.doc	Supplementary Document	Uploaded 2016-04-25	Repair queued
Att A -NCHS Legislation.doc	Supplementary Document	Uploaded 2016-04-25	Available
0920-0943 SupSta B_4-12-16.docx	Supporting Statement B	Uploaded 2016-04-26	Available
0920-0943 SupSta A _4-12-16.doc	Supporting Statement A	Uploaded 2016-04-26	Available
Att E-2 _First Mailing packet.docx	Supplementary Document	Uploaded 2016-04-25	Repair queued
Att E-5_Follow-up #2 packet.docx	Supplementary Document	Uploaded 2016-04-25	Available
Att E-4_Follow-up #1 packet.docx	Supplementary Document	Uploaded 2016-04-25	Available
Att E-3_Thank You Reminder letters.docx	Supplementary Document	Uploaded 2016-04-25	Repair queued
Att E-1_Advance Notification letters- Experiment 1.docx	Supplementary Document	Uploaded 2016-04-25	Repair queued
Att C-1 NSLTCP 2014 to 2016 RCC changes.xlsx	Supplementary Document	Uploaded 2016-04-25	Repair queued
Att C-2 NSLTCP 2014 to 2016 ADSC changes.xlsx	Supplementary Document	Uploaded 2016-04-25	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
221244	Data Retrieval Telephone Call	Other-WORD	New
210276	2016 Adult Day Services Center Questionnaire-Version B	Form	Modified
202805	2016 Adult Day Services Center Questions-Version A	Form	Modified
202804	2016 Residential Care Community Questions-Version B	Form	Modified
202803	2016 Residential Care Community Questions-Version A	Form	Modified

ICR Details

OMB Control No: 0920-0943	ICR Reference No: 201604-0920-007
Status: Historical Active	Previous ICR Reference No: 201402-0920-003
Agency/Subagency: HHS/CDC	Agency Tracking No: 12BZ
Title: Data Collection for the Residential Care Community and Adult Day Services Center Components of the National Study of Long-term Care Providers
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/27/2016
	Date Received in OIRA: 04/27/2016
Terms of Clearance: Approved consistent with NCHS' plan to continue to explore ways to characterize (and if necessary, adjust for) non-response bias and explore ways to address these issues.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2019	36 Months From Approved
Responses	8,974	0	0
Time Burden (Hours)	4,310	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This request is for a reinstatement with nonsubstantive changes to collect data for the residential care community (RCC) and adult day services center (ADSC) components for the 2016 wave of the National Study of Long-Term Care Providers (NSLTCP). NSLTCP will be administered by mail, web, and telephone, and data will be collected from a sample of 11,690 RCCs and a census of about 5,400 ADSCs in the 50 states and the District of Columbia.

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Authorizing Statute(s): US Code: 42 USC 242k Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 69678	11/10/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 23495	04/21/2016
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 5

table that charts list of burden

IC Title	Form No.	Form Name
2016 Adult Day Services Center Questions-Version A	NONE	National Study of Long-Term Care Providers--2016 Adult Day Services Center Questions-Version A
2016 Adult Day Services Center Questionnaire-Version B	NONE	National Study of Long-Term Care Providers--2016 Adult Day Services Center Questions-Version B
Data Retrieval Telephone Call
2016 Residential Care Community Questions-Version A	NONE	National Study of Long Term Care Providers--2016 Residential Care Community Questions-Version A
2016 Residential Care Community Questions-Version B	NONE	National Study of Long Term Care Provider --2016 Residential Care Community Questions-Version B

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	8,974	0	0	8,974	0	0
Annual Time Burden (Hours)	4,310	0	0	4,310	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: As a result of the addition, deletion, and revision of select items, along with the development of two versions of the question for both the directors of Residential Care Communities and Adult Day Services Centers, this submission includes a decrease 10,397 respondents and 4,626 burden hours.

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Annual Cost to Federal Government: $1,089,446

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 04/27/2016

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