Information Collection

Community Nursing Home Program Interviews

IC 232508 under ICR 201710-2900-001 · OMB 2900-0770.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0770 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
CNH Value Interview Guide- Cover w_seal and PRA.docx	Other-Interview
Generic Clearance Submission - CNHP Interviews.doc Generic Request - CNHP Interview	IC Document

IC Title:

Community Nursing Home Program Interviews

Agency IC Tracking Number:

2900-0770

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?	Can Be Submitted Electronically?	Electronic Capability
Other-Interview			CNH Value Interview Guide- Cover w_seal and PRA.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 140

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	140	140
Annual IC Time Burden (Hours)	140	140
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Generic Request - CNHP Interview	Generic Clearance Submission - CNHP Interviews.doc	08/01/2018

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