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 Data Retrieval	Form	New	Available
Form 0920-0943 RCC/ADSC Sampling and Services User Questionnaire	Form and Instruction	Removed	Available
Form 0920-0943 ADSC Provider Questionnaire	Form and Instruction	Modified	Available
Form 0920-0943 RCC Provider Questionnaire	Form and Instruction	Modified	Available
Form 0920-0943 RCC/ADSC Screener and Appointment Setting Call Script	Form	Removed	Available
Form 0920-0943 RCC/ADSC Contact Confirmation Call Script	Form	Removed	Available
Att H Select Prior Studies.docx	Supplementary Document	Uploaded 2020-07-27	Available
Att G Human Subjects Research Determination.docx	Supplementary Document	Uploaded 2020-07-27	Available
Att F Chain letter and FAQs.docx	Supplementary Document	Uploaded 2020-07-27	Available
Att E-8 Mailing #3 letter and FAQs.docx	Supplementary Document	Uploaded 2020-07-27	Available
Att E-7 Mailing #2 letter and FAQs.docx	Supplementary Document	Uploaded 2020-07-27	Available
Att E-6 Thank You Reminder letters and emails.docx	Supplementary Document	Uploaded 2020-07-27	Repair queued
Att E-5 NCHS Strictly Confidential Brochure final.docx	Supplementary Document	Uploaded 2020-07-27	Available
Att E-4 Letters of Support.docx	Supplementary Document	Uploaded 2020-07-27	Available
Att E-3 Resident and Participant NCHS Data Briefs.docx	Supplementary Document	Uploaded 2020-07-27	Available
Att E-2 Mailing #1 letter and FAQs.docx	Supplementary Document	Uploaded 2020-07-27	Available
Att E-1 Advance notification letter_v2.docx	Supplementary Document	Uploaded 2020-07-27	Available
Att D-2 ADSC Question Changes_v2.xlsx	Supplementary Document	Uploaded 2020-07-27	Available
Att D-1 RCC Question Changes_v2.xlsx	Supplementary Document	Uploaded 2020-07-27	Available
Att B Sixty-day Notice in Federal Register.docx	Supplementary Document	Uploaded 2020-07-27	Repair queued
Att A Public Health Service Act (306ab and 308d).docx	Supplementary Document	Uploaded 2020-07-27	Available
2020 NPALS SupSta B 071020.docx	Supporting Statement B	Uploaded 2020-07-27	Repair queued
2020 NPALS SupSta A 071020 final.docx	Supporting Statement A	Uploaded 2020-07-27	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
242826	Data Retrieval	Form	New
231012	RCC/ADSC Sampling and Services User Questionnaire	Form and Instruction	Removed
231011	ADSC Provider Questionnaire	Form and Instruction	Modified
231010	RCC Provider Questionnaire	Form and Instruction	Modified
231007	RCC/ADSC Screener and Appointment Setting Call Script	Form	Removed
231004	RCC/ADSC Contact Confirmation Call Script	Form	Removed

ICR Details

OMB Control No: 0920-0943	ICR Reference No: 202007-0920-018
Status: Active	Previous ICR Reference No: 201803-0920-001
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: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/03/2020
	Date Received in OIRA: 07/28/2020
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2023	24 Months From Approved
Responses	8,978	0	0
Time Burden (Hours)	4,311	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: This request is for a Reinstatement with change 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 reinstatement involves minor changes to the instruments including addition of COVID-19 questions. The number of respondents and the burden have increased as well.

---

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

Citations for New Statutory Requirements: None

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 57431	10/25/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 45433	07/28/2020
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
ADSC Provider Questionnaire	0920-0943	ADSC Provider Questionnaire
RCC Provider Questionnaire	0920-0943	RCC Questionnaire
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
RCC/ADSC Sampling and Services User Questionnaire	0920-0943	RCC/ADSC Sampling and Services User Questionnaire
Data Retrieval	0920-0943	Data Retrieval

---

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	8,978	0	0	8,978	-10,488	10,488
Annual Time Burden (Hours)	4,311	0	0	4,311	-2,751	2,751
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: No

Burden Reduction Due to:

Short Statement: The burden increase is due to the increase in respondents.

---

Annual Cost to Federal Government: $1,410,970

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? Yes

---

Common Form ICR:  No

---

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: 07/28/2020

---