Information Collection Request

Process Evaluation and Special Studies Related to the Long-Term Care Ombudsman Program

ICR 201612-0985-003 · OMB 0985-0055 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 1 Volunteers Survey Form New Available
Form 1 Local Directors/Regional Representaitves and Local Representatives Form New Repair queued
Form 1 State Ombudsman Interview Protocol and Survey Form New Available
Form 1 National Stakeholders Interview Protocol Form New Available
Form 1 Federal Staff National Stakeholders Form New Available
OMB Package Section B_FINAL.docx Supporting Statement B Uploaded 2016-12-16 Available
OMB Package Section A-FINAL-REVISED.docx Supporting Statement A Uploaded 2016-12-16 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
224906 Volunteers Survey Form New
224905 Local Directors/Regional Representaitves and Local Representatives Form New
224903 State Ombudsman Interview Protocol and Survey Form New
224895 National Stakeholders Interview Protocol Form New
224893 Federal Staff National Stakeholders Form New

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
03/31/2020 36 Months From Approved
765 0 0
484 0 0
0 0 0





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 765 0 0 765 0 0
Annual Time Burden (Hours) 484 0 0 484 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No