Line 7 National Survey Facility Questionnaire

National Survey of Residential Care Facilities (NSRCF) 2008-2010

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0780 can be found here:

Documents and Forms

Document Name Document Type
Form 7 Line 7 National Survey Facility Questionnaire Form and Instruction
7 National Survey Facility Questionnaire Attachment O-National Facility Qx[1].12192007.doc Form and Instruction

Information Collection (IC) Details

IC Title:	Line 7 National Survey Facility Questionnaire	Agency IC Tracking Number:

Is this a Common Form? Yes		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	7	National Survey Facility Questionnaire	Attachment O-National Facility Qx[1].12192007.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Health Resources Utilization Statistics	FR Citation: 49 FR 37697

Number of Respondents: 750	Number of Respondents for Small Entity: 200

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	750	750
Annual IC Time Burden (Hours)	500	500
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.