0920-1030 Telephone Protocol

Attachment A: Semi Structured Telephone Protocol

Form Approved

OMB No. 0920-1030

Exp. Date 04/30/2020

NOTICE –CDC estimates the average public reporting burden for this collection of information as 30 minutes per response, including the time for reviewing instructions, searching existing data/information sources, gathering and maintaining the data/information needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-1030).

Assurance of Confidentiality – We take your privacy very seriously. All information that relates to or describes identifiable characteristics of individuals, a practice, or an establishment will be used only for statistical purposes. NCHS staff, contractors, and agents will not disclose or release responses in identifiable form without the consent of the individual or establishment in accordance with section 308(d) of the Public Health Service Act (42 U.S.C. 242m(d)) and the Confidential Information Protection and Statistical Efficiency Act of 2002 (CIPSEA, Title 5 of Public Law 107-347). In accordance with CIPSEA, every NCHS employee, contractor, and agent has taken an oath and is subject to a jail term of up to five years, a fine of up to $250,000, or both if he or she willfully discloses ANY identifiable information about you.

Introduction and verification of state government representative’s name, agency, and position.

Explain why calling

• We are asking for your help as we construct the residential care sampling frame. The sampling frame will be used to draw a nationally representative sample for the 2020 wave of NPALS.

  • Phone call takes on average 30 minutes to complete, and there may be an additional 1 hour needed for building an updated or more complete electronic listing that includes the needed information on each facility.

Share confidentiality, informed consent, and voluntary participation information

• All information which would permit identification of an individual, a practice, or an establishment will be held confidential, and will be used for statistical purposes only by NCHS staff and agents and will not be disclosed or released to other persons without your consent. If you have any questions about your rights as a participant in this research study, call NCHS’ Confidentiality Officer at (888) 642-1459.

• Participation is voluntary, but will assist greatly in helping further our nation’s understanding of residential care communities

Begin interview:

• Verify phone number and mailing/email address for follow-up

• Provide study definition of residential care community.

• Discuss state’s current licensure categories for residential care communities and whether they meet the study definition and/or challenges in determining this.

• Discuss your state’s website listing. Verify information on website list is current.

• Ask for additional/missing information (complete listing will have the name and geographic and mailing address of the residential care community, name of community director, licensure category, number of beds/units, types of residents, chain affiliation, and ownership).

• Come up with an action plan and timeline for electronic file development/delivery

• Ask if they are aware of any upcoming changes to the regulations regarding residential care in their state in the next two years.

• Ask if the state has a sense of the rate of openings and closures within the state

Thank you and closure.

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