Frame Development for the Residential Care Component of the National Post-Acute and Long-Term Care Study

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⚠️ Notice: This information collection may be referencing outdated material.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
Form 0920-1030 Frame Development for the Residential Care Component of the National Post-Acute and Long-Term Care Study Form
0920-1030 Contact Information Verification Attachment B-1 Advance Package Contact Info Verification.doc Form
0920-1030 Telephone Protocol Attachment A NSLTCP Frame Telephone Protocol.doc Form
0920-1030 Elecvtronic File Development Attachment C-Electronic File Development.docx Form
Attachment B-2 NSLTCP Frame Advance Package NCHS Letter.doc NSLTCP Frame Advance Package NCHS Letter IC Document
Attachment B-3 Letter of Support.doc Letter of Support IC Document
Attachment B-4 Advance Package NCHS Confidentiality Brochure.doc Confidential Brochure IC Document
Attachment D Human Subjects Determination.doc Research Determination IC Document
Attachment E-Thank You Letter.doc Thank You Letter IC Document
NSLTCP Frame Supp State A_6.6.19.doc Supporting Statement A IC Document
NSLTCP Frame Supp State B_6.6.19.doc Supporting Statement B IC Document

Information Collection (IC) Details

IC Title:	Frame Development for the Residential Care Component of the National Post-Acute and Long-Term Care Study	Agency IC Tracking Number:	0920-1030-19BGJ

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Electronic Capability
Form	0920-1030	Contact Information Verification	Attachment B-1 Advance Package Contact Info Verification.doc	NA	No	Paper Only
Form	0920-1030	Telephone Protocol	Attachment A NSLTCP Frame Telephone Protocol.doc	NA	No	Paper Only
Form	0920-1030	Elecvtronic File Development	Attachment C-Electronic File Development.docx	NA	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

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

Number of Respondents: 261	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	261	261
Annual IC Time Burden (Hours)	138	138
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
NSLTCP Frame Advance Package NCHS Letter	Attachment B-2 NSLTCP Frame Advance Package NCHS Letter.doc	07/19/2019
Letter of Support	Attachment B-3 Letter of Support.doc	07/19/2019
Confidential Brochure	Attachment B-4 Advance Package NCHS Confidentiality Brochure.doc	07/19/2019
Research Determination	Attachment D Human Subjects Determination.doc	07/19/2019
Thank You Letter	Attachment E-Thank You Letter.doc	07/19/2019
Supporting Statement A	NSLTCP Frame Supp State A_6.6.19.doc	07/19/2019
Supporting Statement B	NSLTCP Frame Supp State B_6.6.19.doc	07/19/2019

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