Data Collection for the Residential Care Community and Adult Day Services Center Components of the National Study of Long-term Care Providers

Forms and Documents

Document Name	Status
Data Retrieval Telephone Call Questionnaire Form	Modified
Adult Day Services Center Questionnaire Form	Modified
Residential Care Community Questionnaire Form	Modified
2014 NSLTCP Supporting Statement-revised.doc Justification for No Material/Nonsubstantive Change	2014-03-15
Attachment C-7 Chain packet letters.doc Supplementary Document	2014-01-31
Attachment C-6 Trouble Reaching You letters.docx Supplementary Document	2014-01-31
Attachment C-5 Thank You Reminder letters.docx Supplementary Document	2014-01-31
Attachment C-4 Follow up #2 letters.docx Supplementary Document	2014-01-31
Attachment C-3 Follow-up #1 letters.docx Supplementary Document	2014-01-31
Attachment C-2 First Mailing Letters.docx Supplementary Document	2014-01-31
Attachment C-1 Advance Notification letters.docx Supplementary Document	2014-01-31
Attachment A-2 NSLTCP 2012 to 2014 RCC changes.xlsx Supplementary Document	2014-01-31
Attachment A-1 NSLTCP 2012 to 2014 ADSC changes.xlsx Supplementary Document	2014-01-31
2014 NSLTCP Supporting Statement 012314.doc Justification for No Material/Nonsubstantive Change	2014-01-31

IC Document Collections

IC ID	Document Title	Status
210276	RCC and ADSC Directors Follow-up Call Other-Phone Interview Questions	New
202805	Data Retrieval Telephone Call Questionnaire Form	Modified
202804	Adult Day Services Center Questionnaire Form	Modified
202803	Residential Care Community Questionnaire Form	Modified

ICR Details

OMB Control No: 0920-0943	ICR Reference No: 201402-0920-003
Status: Historical Active	Previous ICR Reference No: 201206-0920-004
Agency/Subagency: HHS/CDC	Agency Tracking No: 21385
Title: Data Collection for the Residential Care Community and Adult Day Services Center Components of the National Study of Long-term Care Providers
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/15/2014
	Date Received in OIRA: 02/04/2014
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2015	07/31/2015	07/31/2015
Responses	19,371	0	18,371
Time Burden (Hours)	8,936	0	8,769
Cost Burden (Dollars)	0	0	0

---

Abstract: The National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention (CDC), seeks approval for a nonsubstantive change to an approved project (OMB No. 0920-0943 Exp. Date: 07/31/2015), data collection for the residential care community (RCC) and adult day services center (ADSC) components for the National Study of Long-Term Care Providers (NSLTCP), including the estimated sample size and estimated annual burden. As we did in 2012, the data to be collected from RCCs and ADSCs will include basic characteristics, services offered, staffing, and practices of providers, as well as distributions of the demographics, physical functioning, and cognitive functioning of users (RCC residents and ADSC participants) aggregated to the RCC/ADSC level. The 2014 NSLTCP will be administered by mail, web, and telephone. As we did in 2012, data will be collected from a sample of 11,690 RCCs and a census of 5,000 ADSCs in the 50 states and the District of Columbia.

---

Authorizing Statute(s): US Code: 42 USC 242k Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 4

IC Title	Form No.	Form Name
Residential Care Community Questionnaire	none	2014 RCC Questions
Adult Day Services Center Questionnaire	none	ADSC Questions
Data Retrieval Telephone Call Questionnaire	none	Data Retrieval Call
RCC and ADSC Directors Follow-up Call

---

ICR Summary 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	19,371	18,371	0	1,000	0	0
Annual Time Burden (Hours)	8,936	8,769	0	167	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This change request provides questions for 2014 and adds a follow-up call which increases burden.

---

Annual Cost to Federal Government: $1,903,248

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 02/04/2014

---