Information Collection Request

Outcome Evaluation of the Long-Term Care Ombudsman Program (LTCOP)

ICR 202008-0985-001 · OMB 0985-0069 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Survey-Former Ombudsmen Form and Instruction New Available
SUA Director Survey Form and Instruction New Repair queued
Interview-Stakeholders Form and Instruction New Available
Focus Group Residents and Family Members Form New Repair queued
Focus Group-Facility Staff Form New Available
Facility Administrator Survey Form and Instruction New Available
LTCOP ACL Response to OMB comment 091720.docx Supplementary Document Uploaded 2020-09-17 Available
0985-New LTCOP OMB Package Section A_07-13-2020.docx Supporting Statement A Uploaded 2020-08-04 Available
0985-New LTCOP Part B_022120_rev 7-27-2020.docx Supporting Statement B Uploaded 2020-08-03 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
242981 Stakeholders/ State Unit on Aging (SUA) Directors/Former Ombudsmen Form and Instruction NewSurvey-Former Ombudsmen
242981 Stakeholders/ State Unit on Aging (SUA) Directors/Former Ombudsmen Form and Instruction NewSUA Director Survey
242981 Stakeholders/ State Unit on Aging (SUA) Directors/Former Ombudsmen Form and Instruction NewInterview-Stakeholders
242980 Focus Group-Residents and Family Form NewFocus Group Residents and Family Members
242980 Focus Group-Residents and Family Other-Focus Group Guide New
242979 Focus Group-Facility Administrators and Staff Form NewFocus Group-Facility Staff
242979 Focus Group-Facility Administrators and Staff Form and Instruction NewFacility Administrator Survey
242979 Focus Group-Facility Administrators and Staff Other-Focus Group Guide New

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
09/30/2023 36 Months From Approved
1,985 0 0
715 0 0
0 0 0





Reginfo record details
3
table that charts list of burden
IC Title Form No. Form Name
Focus Group-Facility Administrators and Staff NA, NA ,  
Focus Group-Residents and Family NA
Stakeholders/ State Unit on Aging (SUA) Directors/Former Ombudsmen NA, NA, NA ,   ,  

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 1,985 0 0 1,985 0 0
Annual Time Burden (Hours) 715 0 0 715 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No