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Federal forms, ICRs, and supporting documents

Information Collection

ADSC Provider Questionnaire

IC 231011 under ICR 202504-0920-018 · OMB 0920-0943.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form
Form
Information Collection (IC) Details

View Information Collection (IC)

ADSC Provider Questionnaire 0920-25-0097
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction None 2024 Adult Day Services Center Questionnaire Att C-2 ADSC questionnaire 0524.docx Yes Yes Fillable Fileable
Form 0920-25-0097 0920-0943 NPALS_ADSC_Final_Updated 0920-0943 NPALS_ADSC_Final_Updated TEXT VERSION.docx Yes Yes Fillable Fileable

Health Public Health Monitoring

Health Resources Utilization Statistics  49 FR 37697

2,750 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   50 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 2,750 0 0 0 0 2,750
Annual IC Time Burden (Hours) 1,375 0 0 0 0 1,375
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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