[NCHS] Direct Care Worker Pilot Study

Developmental Studies to Improve the National Health Care Surveys

Documents and Forms

Document Name Document Type
[NCHS] Direct Care Worker Pilot Study Form and Instruction
Director Sampling Appointment Setting Call Att B-1 Director Sampling Appointment Setting Call 5.11.23_final.docx Form and Instruction
Director DCS Sampling Call Att B-3 Director DCW Sampling Call 5.11.23_final.docx Form and Instruction
DCW Draft Question List Att C DCW draft question List 5.11.23_final.docx Form and Instruction
Att A-1 Director mailing NCHS Cover Letter with FAQs 5.17.23.docx Director Mailing Cover Letter with FAQs IC Document
Att A-2 DCW NCHS Cover Letter with FAQs 5.17.23.docx DCW Mailing Cover Letter with FAQs IC Document
Att A-3 NCHS Strictly Confidential Brochure 5.11.23.docx Strictly Confidential Brochure IC Document
Att B-2 CATI Confirmation and Prep Letter or email.docx CATI Confirmation and Prep Letter/Email IC Document
Att D-1 Thank You Reminder letters 5.17.23.docx Thank You Reminder Letters IC Document
Att D-2 Prompting emails 5.17.23.docx Prompting Letters IC Document
Att E Human Subjects Determination 5.17.23.docx Human Subjects Determination IC Document
NPALS DCW Pilot Supp State A_5.16.23_final.docx SSA IC Document
NPALS DCW Pilot Supp State B_5.16.23.docx SSB IC Document

Information Collection (IC) Details

IC Title:	[NCHS] Direct Care Worker Pilot Study	Agency IC Tracking Number:	0920-1030-23FI

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	n/a	Director Sampling Appointment Setting Call	Att B-1 Director Sampling Appointment Setting Call 5.11.23_final.docx	No		Fillable Fileable
Form and Instruction	n/a	Director DCS Sampling Call	Att B-3 Director DCW Sampling Call 5.11.23_final.docx	No		Fillable Fileable
Form and Instruction	n/a	DCW Draft Question List	Att C DCW draft question List 5.11.23_final.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Health Resources Utilization Statistics	FR Citation: 59 FR 48331

Number of Respondents: 1,440	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 40 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,440	1,440
Annual IC Time Burden (Hours)	480	480
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Director Mailing Cover Letter with FAQs	Att A-1 Director mailing NCHS Cover Letter with FAQs 5.17.23.docx	05/22/2023
DCW Mailing Cover Letter with FAQs	Att A-2 DCW NCHS Cover Letter with FAQs 5.17.23.docx	05/22/2023
Strictly Confidential Brochure	Att A-3 NCHS Strictly Confidential Brochure 5.11.23.docx	05/22/2023
CATI Confirmation and Prep Letter/Email	Att B-2 CATI Confirmation and Prep Letter or email.docx	05/22/2023
Thank You Reminder Letters	Att D-1 Thank You Reminder letters 5.17.23.docx	05/22/2023
Prompting Letters	Att D-2 Prompting emails 5.17.23.docx	05/22/2023
Human Subjects Determination	Att E Human Subjects Determination 5.17.23.docx	05/22/2023
SSA	NPALS DCW Pilot Supp State A_5.16.23_final.docx	05/22/2023
SSB	NPALS DCW Pilot Supp State B_5.16.23.docx	05/22/2023

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.