Information Collection

[NCHS] Adding Incentives Experiments to the Direct Care Worker Pilot Study

IC 266335 under ICR 202212-0920-005 · OMB 0920-1030.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
DCW Questionnaire [NCHS] Adding Incentives Experiments to the Direct Care Worker Pilot Study	Form and Instruction
Att A-1 Director Incentive_Cover Letter_final.docx	Instruction
DCW Questionnaire Att B DCW question List.docx	Form and Instruction
Att A-2 DCW Incentive_Cover Letter.docx DCW Incentive Cover Letter	IC Document
Att A-3 NCHS Confidential Brochure.docx NCHS Confidential Brochure	IC Document
Att C DCW Thank You letter.docx DCW Thank You Letter	IC Document
Att D Human Subjects Determination.docx HS Determination	IC Document
Att E_DCW Pilot Flyer.pdf DCW Pilot Flyer	IC Document
NPALS DCW Pilot Supp State A_Incentives_final.docx SSA	IC Document
NPALS DCW Pilot Supp State B_Incentives_final.docx SSB	IC Document

IC Title:

Agency IC Tracking Number:

0920-1030-24EF

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction					Yes	No	Fillable Fileable
Form and Instruction	n/a				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 254

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 90 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	254	254
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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

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