Information Collection Request

Evaluation of the Supportive Services Demonstration

ICR 202005-2528-001 · OMB 2528-0321 · Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
30 day FRN.pdf Supplementary Document Uploaded 2020-07-05 Available
2528-0321 60 Day Notice.pdf Supplementary Document Uploaded 2020-06-16 Available
final-6-15-20 -SSDE Supporting Statement Part B.docx Supporting Statement B Uploaded 2020-06-16 Available
final-6-15-20 -SSDE Supporting Statement Part A.docx Supporting Statement A Uploaded 2020-06-16 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
242278 Interviews with owner organizations Other-Interviews with owner organizations New
242276 Interviews with Service Coordinators Other-Interviews with Service Coordinators New
242275 Interviews with Wellness Nurses Other-Interviews with Wellness Nurses New
242274 Interviews with Resident Wellness Directors Other-Interviews with Resident Wellness Directors New
232278 Focus Groups with Caregivers Other-Moderator Guide for Focus Groups with Caregivers of IWISH Removed
232277 Focus Groups with Residents Other-Moderator Guide for Focus Groups with IWISH Participants Removed
232276 Interviews Other-Interview Guide for Wellness Directors at Treatment Proper Removed
232275 Initial Questionnaire Other-Initial Questionnaire for Treatment Properties Removed

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
08/31/2023 36 Months From Approved 11/30/2021
156 0 580
234 0 1,151
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 156 580 0 -424 0 0
Annual Time Burden (Hours) 234 1,151 0 -917 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No