Focus Group-Facility Administrators and Staff

Outcome Evaluation of the Long-Term Care Ombudsman Program (LTCOP)

Documents and Forms

Document Name Document Type
Focus Group-Facility Administrators and Staff Form and Instruction
0985-New Draft Focus Group Guide_Facility Staff (7).pdf Other-Focus Group Guide
Facility Administrator Survey 0985-New Draft Survey_Facility Administrator (3).pdf Form and Instruction
Focus Group-Facility Staff 0985-New Draft Focus Group Participant Info_Facility Staff (8).pdf Form

Information Collection (IC) Details

IC Title:	Focus Group-Facility Administrators and Staff	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	NA	Facility Administrator Survey	0985-New Draft Survey_Facility Administrator (3).pdf	Yes	Yes	Fillable Fileable
Other-Focus Group Guide			0985-New Draft Focus Group Guide_Facility Staff (7).pdf	Yes	Yes	Fillable Fileable
Form	NA	Focus Group-Facility Staff	0985-New Draft Focus Group Participant Info_Facility Staff (8).pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,856	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 75 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,856	1,856
Annual IC Time Burden (Hours)	612	612
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.