2016 Adult Day Services Center Questions-Version A

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0943 can be found here:

Documents and Forms

Document Name Document Type
2016 Adult Day Services Center Questions-Version A Form
National Study of Long-Term Care Providers--2016 Adult D Att D-3 _2016 ADSC questions Version A 031816.docx Form
Att I-2 ADSC Web Questionnaire Screenshots.docx Att I-2 ADSC Web Questionnaire Screenshots IC Document

Information Collection (IC) Details

IC Title:	2016 Adult Day Services Center Questions-Version A	Agency IC Tracking Number:	15BZ

Is this a Common Form? No		IC Status: Modified

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
Form	NONE	National Study of Long-Term Care Providers--2016 Adult Day Services Center Questions-Version A	Att D-3 _2016 ADSC questions Version A 031816.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title: Health Resources Utilization Statistics	FR Citation: 49 FR 37697

Number of Respondents: 1,350	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,350	1,350
Annual IC Time Burden (Hours)	675	675
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Att I-2 ADSC Web Questionnaire Screenshots	Att I-2 ADSC Web Questionnaire Screenshots.docx	04/25/2016

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