Frame Development for the Residential Care Component of the National Study of Long-Term Care Providers

Developmental Studies to Improve the National Health Care Surveys

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1030 can be found here:

Documents and Forms

Document Name Document Type
Frame Development for the Residential Care Component of the National Study of Long-Term Care Providers Form and Instruction
Semi-Structured Telephone Protocol Attachment A NSLTCP Frame Telephone Protocol 042717.doc Form and Instruction
Contact Information Verification Attachment B-1 Advance Package Contact Info Verification 042717.doc Form and Instruction
Electronic File Development Attachment C-Electronic File Development 042717.docx Form and Instruction
NSLTCP Frame Part A 050917.doc Supporting Statement Part A IC Document
Attachment B-2 NSLTCP Frame Advance Package NCHS Letter_042717.doc Advance Package Letter IC Document
Attachment B-3 Letter of Support 042717.doc Letter of Support IC Document
Attachment B-4 Advance Package NCHS Confidentiality Brochure_042717.doc NCHS Confidentilality Brochure IC Document
Attachment D Human Subjects Determination_042717.doc Human Subjects Determination IC Document
Attachment E-Thank You Letter_042717.doc Thank You Letter IC Document

Information Collection (IC) Details

IC Title:	Frame Development for the Residential Care Component of the National Study of Long-Term Care Providers	Agency IC Tracking Number:	0920-17AIZ

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	N/A	Semi-Structured Telephone Protocol	Attachment A NSLTCP Frame Telephone Protocol 042717.doc	No		Paper Only
Form and Instruction	N/A	Contact Information Verification	Attachment B-1 Advance Package Contact Info Verification 042717.doc	No		Paper Only
Form and Instruction	N/A	Electronic File Development	Attachment C-Electronic File Development 042717.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 87	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	87	87
Annual IC Time Burden (Hours)	138	138
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement Part A	NSLTCP Frame Part A 050917.doc	05/12/2017
Advance Package Letter	Attachment B-2 NSLTCP Frame Advance Package NCHS Letter_042717.doc	05/12/2017
Letter of Support	Attachment B-3 Letter of Support 042717.doc	05/12/2017
NCHS Confidentilality Brochure	Attachment B-4 Advance Package NCHS Confidentiality Brochure_042717.doc	05/12/2017
Human Subjects Determination	Attachment D Human Subjects Determination_042717.doc	05/12/2017
Thank You Letter	Attachment E-Thank You Letter_042717.doc	05/12/2017

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