Data Collection for the Residential Care Community and Adult Day Services Center Components of the National Study of Long-term Care Providers

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920-0943 RCC/ADSC Sampling and Services User Questionnaire	Form and Instruction	New	Available
Form 0920-0943 ADSC Provider Questionnaire	Form and Instruction	New	Available
Form 0920-0943 RCC Provider Questionnaire	Form and Instruction	New	Available
Form 0920-0943 RCC/ADSC Screener and Appointment Setting Call Script	Form	New	Available
Form 0920-0943 RCC/ADSC Contact Confirmation Call Script	Form	New	Available
2016 Adult Day Services Center Questionnaire-Version B	Form	Removed	Available
2016 Adult Day Services Center Questions-Version A	Form	Removed	Available
2016 Residential Care Community Questions-Version B	Form	Removed	Repair queued
2016 Residential Care Community Questions-Version A	Form	Removed	Repair queued
Attachment J Services User CATI Confirmation and Prep Email or Mail Text 11-28-17.doc	Supplementary Document	Uploaded 2018-04-10	Available
Attachment I-3 Provider Questionnaire Thank you Email or Mail_11-28-17.doc	Supplementary Document	Uploaded 2018-04-10	Available
Attachment I-2 010518.docx	Supplementary Document	Uploaded 2018-04-10	Available
Attachment I-1 First Provider Questionnaire Email or Mail Text _11-28-17.docx	Supplementary Document	Uploaded 2018-04-10	Available
Attachment G-5 Advance Package NCHS Strictly Confidential Brochure 11-28-17.docx	Supplementary Document	Uploaded 2018-04-10	Available
Attachment G-4 Advance Package ERB Approval Letter 11-28-17.docx	Supplementary Document	Uploaded 2018-04-10	Available
Attachment G-3 Advance Package Letters of Support_11-28-17.docx	Supplementary Document	Uploaded 2018-04-10	Available
Attachment G-2 Advance Package Resident and Participant NCHS Data Briefs_11-28-17.docx	Supplementary Document	Uploaded 2018-04-10	Available
Attachment G-1 Advance Package-NCHS Cover Letter with FAQs 11-28-17.docx	Supplementary Document	Uploaded 2018-04-10	Repair queued
Attachment E Protocol Flow Chart_11-28-17.docx	Supplementary Document	Uploaded 2018-04-10	Available
Attachment D External Expert Reviewers 011618.docx	Supplementary Document	Uploaded 2018-04-10	Repair queued
Attachment A Public Health Service Act (306ab and 308d)_11-28-17.docx	Supplementary Document	Uploaded 2018-04-10	Available
2018 Supp Statement B 10APR2018.docx	Supporting Statement B	Uploaded 2018-04-10	Available
2018 Supp Statement A 10APR2018.doc	Supporting Statement A	Uploaded 2018-04-10	Available
Attachment B2 Public Comments.docx	Supplementary Document	Uploaded 2018-04-09	Available
Attachment B1 Sixty-day Notice 011618.pdf	Supplementary Document	Uploaded 2018-04-09	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
231012	RCC/ADSC Sampling and Services User Questionnaire	Form and Instruction	New
231011	ADSC Provider Questionnaire	Form and Instruction	New
231010	RCC Provider Questionnaire	Form and Instruction	New
231007	RCC/ADSC Screener and Appointment Setting Call Script	Form	New
231004	RCC/ADSC Contact Confirmation Call Script	Form	New
221244	Data Retrieval Telephone Call	Other-WORD	Removed
210276	2016 Adult Day Services Center Questionnaire-Version B	Form	Removed
202805	2016 Adult Day Services Center Questions-Version A	Form	Removed
202804	2016 Residential Care Community Questions-Version B	Form	Removed
202803	2016 Residential Care Community Questions-Version A	Form	Removed

ICR Details

OMB Control No: 0920-0943	ICR Reference No: 201803-0920-001
Status: Historical Active	Previous ICR Reference No: 201604-0920-007
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-0943
Title: Data Collection for the Residential Care Community and Adult Day Services Center Components of the National Study of Long-term Care Providers
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/10/2018
	Date Received in OIRA: 04/11/2018
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2019	12 Months From Approved	05/31/2019
Responses	13,496	0	8,974
Time Burden (Hours)	4,256	0	4,310
Cost Burden (Dollars)	0	0	0

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Abstract: This request is for a Revision of OMB Control Number 0920-0943 - Data Collection for the Residential Care Community and Adult Day Services Center Components of the National Study of Long-term Care Providers. The goal of this study is to collect data for the residential care community (RCC) and adult day services center (ADSC) survey components of the 4th National Study of Long-Term Care Providers (NSLTCP). The data to be collected will include the basic characteristics, services, staffing, and practices of RCCs and ADSCs, and the demographics, selected health conditions and health care utilization, physical functioning, and cognitive functioning of RCC residents and ADSC participants. This Revision results in an overall net reduction of Burden Hours, due to the elimination of a former data retrieval call that was previously included to allow for errors or omissions in returned surveys that required a call to reach back out to the Directors or their designated staff member. The 2018 NSLTCP includes the introduction of a services user questionnaire which was not part of the previous submission.

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Authorizing Statute(s): US Code: 42 USC 242k Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

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EO 13771 Designation: Deregulatory

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 60198	12/19/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 14857	04/06/2018
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 5

table that charts list of burden

IC Title	Form No.	Form Name
2016 Residential Care Community Questions-Version A	NONE	National Study of Long Term Care Providers--2016 Residential Care Community Questions-Version A
2016 Residential Care Community Questions-Version B	NONE	National Study of Long Term Care Provider --2016 Residential Care Community Questions-Version B
RCC/ADSC Contact Confirmation Call Script	0920-0943	RCC/ADSC Contact Confirmation Call Script
RCC/ADSC Screener and Appointment Setting Call Script	0920-0943	RCC/ADSC Screener and Appointment Setting Call Script
2016 Adult Day Services Center Questionnaire-Version B	NONE	National Study of Long-Term Care Providers--2016 Adult Day Services Center Questions-Version B
ADSC Provider Questionnaire	0920-0943	ADSC Provider Questionnaire
RCC/ADSC Sampling and Services User Questionnaire	0920-0943	RCC/ADSC Sampling and Services User Questionnaire
RCC Provider Questionnaire	0920-0943	RCC Provider Questionnaire
Data Retrieval Telephone Call
2016 Adult Day Services Center Questions-Version A	NONE	National Study of Long-Term Care Providers--2016 Adult Day Services Center Questions-Version A

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ICR Summary of Burden

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	13,496	8,974	0	4,522	0	0
Annual Time Burden (Hours)	4,256	4,310	0	-54	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Submission of 0920-0942 is a request for Revision. This Revision results in an overall net reduction of Burden Hours, due to the elimination of a data retrieval call, and includes the introduction of a services user questionnaire which was not part of the previous submission.

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Annual Cost to Federal Government: $2,355,222

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 04/11/2018

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