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Information Collection

Structural Assessments – Cohorts 1, 2 and 3 (baseline, post-intervention)

IC 227697 under ICR 201906-0935-002 · OMB 0935-0238.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Structural Assessments – Cohorts 1, 2 and 3 (baseline, post-intervention)
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction a3 Structural Assessments – Cohorts 1, 2 and 3 Attachment C: Structural Assessment for Long Term Care Setting Attachment C Structural Assessment for the Long-Term Care Setting.1.docx Yes Yes Fillable Fileable
Form and Instruction a2 Structural Assessments – Cohorts 1, 2 and 3 a2 Structural Assessments – Cohorts 1, 2 and 3 Attachment B Structural Assessment for Ambulatory Care.1.docx Yes Yes Fillable Fileable
Form and Instruction a1 Structural Assessments – Cohorts 1, 2 and 3 Attachment A: Structural Assessment for Acute Care Setting Attachment A Structural Assessment for the Acute Care Setting.1.docx Yes Yes Fillable Fileable

Health Health Care Services

 

343 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 686 0 0 0 0 686
Annual IC Time Burden (Hours) 137 0 0 0 0 137
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
No associated records found
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.