Information Collection

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

IC 226827 under ICR 201703-0920-003 · OMB 0920-1030.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.