Information Collection Request

Process Evaluation and Special Studies Related to the Long-Term Care Ombudsman Program

ICR 201712-0985-001 · OMB 0985-0055 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 1 Volunteers Survey Form Unchanged Available
Form 1 Local Directors/Regional Representaitves and Local Representatives Form Unchanged Available
Form 1 State Ombudsman Interview Protocol and Survey Form Unchanged Available
Form 1 National Stakeholders Interview Protocol Form Unchanged Available
Form 1 Federal Staff National Stakeholders Form Unchanged Available
Nonsubstantive Changes for Phase 2 of LTCOP Data Collection (0985-0055) (11-27-17).docx Justification for No Material/Nonsubstantive Change Uploaded 2017-12-01 Available
OMB Package Section B_FINAL.docx Supporting Statement B Uploaded 2016-12-16 Available
OMB Package Section A-FINAL-REVISED.docx Supporting Statement A Uploaded 2016-12-16 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
224906 Volunteers Survey Form Unchanged
224905 Local Directors/Regional Representaitves and Local Representatives Form Unchanged
224903 State Ombudsman Interview Protocol and Survey Form Unchanged
224895 National Stakeholders Interview Protocol Form Unchanged
224893 Federal Staff National Stakeholders Form Unchanged

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
03/31/2020 03/31/2020 03/31/2020
765 0 765
484 0 484
0 0 0





table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 765 765 0 0 0 0
Annual Time Burden (Hours) 484 484 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No