Information Collection

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

IC 237021 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⚠️ Notice: This information collection may be referencing outdated material.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
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.