Information Collection Request

Evaluation of the Supportive Services Demonstration

ICR 202302-2528-001 · OMB 2528-0321 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
30-Day Notice Supportive Services Demonstration.pdf Supplementary Document Uploaded 2023-03-29 Repair queued
60-Day Notice 2528-0321.pdf Supplementary Document Uploaded 2023-03-24 Repair queued
Final - Evaluation of Supportive Services Demonstration Ext-Supporting Statement Part B.docx Supporting Statement B Uploaded 2023-03-24 Repair queued
Final - Supporting Statement A.docx Supporting Statement A Uploaded 2023-03-24 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
259312 Resident Interviews conducted via on demand interpretation Other-Resident Interviews conducted via on demand interpretation New
259311 Resident Interviews conducted in core languages Other-Resident Interviews conducted in core languages New
259310 Interviews with Active Control Group Property Owners and Managers Other-Interviews with Active Control Group Property Owners and M New
259309 Interviews with Treatment Group Property Owners and Managers Other-Interviews with Treatment Group Property Owners and Manage New
259308 Interviews with Wellness Nurses Other-Interviews with Wellness Nurses New
259307 Interviews with Resident Wellness Directors Other-Interviews with Resident Wellness Directors New
242278 Interviews with owner organizations Other-Interviews with owner organizations Removed
242276 Interviews with Service Coordinators Other-Interviews with Service Coordinators Removed
242275 Interviews with Wellness Nurses Other-Interviews with Wellness Nurses Removed
242274 Interviews with Resident Wellness Directors Other-Interviews with Resident Wellness Directors Removed

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
05/31/2026 36 Months From Approved 08/31/2023
328 0 156
724 0 234
0 0 0





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 328 156 0 172 0 0
Annual Time Burden (Hours) 724 234 0 490 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No