ADSC Provider Questionnaire

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

OMB: 0920-0943

IC ID: 231011

Documents and Forms
Information Collection (IC) Details

View Information Collection (IC)

ADSC Provider Questionnaire
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-0943 ADSC Provider Questionnaire Att C-2 ADSC Questionnaire.docx Yes Yes Fillable Fileable

Health Public Health Monitoring

Health Resources Utilization Statistics  49 FR 37697

2,750 770
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   30 %

  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 2,750 0 0 0
Annual IC Time Burden (Hours) 1,375 0 1,375 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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