Information Collection

2016 Adult Day Services Center Questions-Version A

IC 202805 under ICR 201803-0920-001 · OMB 0920-0943.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0943 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
2016 Adult Day Services Center Questions-Version A	Form
National Study of Long-Term Care Providers--2016 Adult D Att D-3 _2016 ADSC questions Version A 031816.docx	Form
Att I-2 ADSC Web Questionnaire Screenshots.docx Att I-2 ADSC Web Questionnaire Screenshots	IC Document

IC Title:

2016 Adult Day Services Center Questions-Version A

Agency IC Tracking Number:

15BZ

Is this a Common Form? No

IC Status: Removed

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
Form	NONE	National Study of Long-Term Care Providers--2016 Adult Day Services Center Questions-Version A	Att D-3 _2016 ADSC questions Version A 031816.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title: Health Resources Utilization Statistics

FR Citation: 49 FR 37697

Number of Respondents: 1,350

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-1,350	1,350
Annual IC Time Burden (Hours)	-675	675
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att I-2 ADSC Web Questionnaire Screenshots	Att I-2 ADSC Web Questionnaire Screenshots.docx	04/25/2016

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