Stakeholders/ State Unit on Aging (SUA) Directors/Former OMBudsmen

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

Documents and Forms

Document Name Document Type
Stakeholders/ State Unit on Aging (SUA) Directors/Former Ombudsmen Form and Instruction
Interview-Stakeholders 0985-New Draft Interview Protocol_Stakeholders (2).pdf Form and Instruction
SUA Director Survey 0985-New Draft Survey_SUA Director (5).pdf Form and Instruction
Survey-Former Ombudsmen 0985-New Draft Survey_Former Ombudsman (4).pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Stakeholders/ State Unit on Aging (SUA) Directors/Former Ombudsmen	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	NA	Interview-Stakeholders	0985-New Draft Interview Protocol_Stakeholders (2).pdf	Yes	Yes	Fillable Fileable
Form and Instruction	NA	SUA Director Survey	0985-New Draft Survey_SUA Director (5).pdf	Yes	Yes	Fillable Fileable
Form and Instruction	NA	Survey-Former Ombudsmen	0985-New Draft Survey_Former Ombudsman (4).pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 105	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	105	105
Annual IC Time Burden (Hours)	79	79
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.