EVALUATION OF BOARD AND CARE HOMES, INTERMEDIATE CARE FACILITIES, AND SINGLE ROOM OCCUPANCIES

Forms and Documents

Document Name	Status

No forms / supporting documents in this ICR. Check IC Document Collections.

IC Document Collections

IC ID	Document Title	Status
116553	EVALUATION OF BOARD AND CARE HOMES, INTERMEDIATE CARE FACILITIES, AND SINGLE ROOM OCCUPANCIES Form	Migrated

ICR Details

OMB Control No: 0990-0063	ICR Reference No: 198101-0990-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/HHSDM	Agency Tracking No:
Title: EVALUATION OF BOARD AND CARE HOMES, INTERMEDIATE CARE FACILITIES, AND SINGLE ROOM OCCUPANCIES
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/01/1981
	Date Received in OIRA: 01/26/1981
Terms of Clearance: This information collection request is approved with the following "Not ascertained" must be removed from the race/ethnic questions. 1. sampling design is to be modified to include 7 states with 75 institutions per state. 2. "not ascertained" must be removed from the race/ethnic questions. 3. In the Resident Interview, the following questions are to deleted: 8 a&b, 9, 10, 16, 17, 25f, h, 29c, d, 32, 33, 35 a&b, 36, 42 b&c, 43 g&h, 44a, e, f, 46 c&d, 49, 50, 51, 52. 4. In tdent Interview, add "watch TV" to activities list in 41c, also, add "help walking, help getting in and out of bed, help getting around outside the residence," to support services in 45a. 5. Delete questions 11 a&b from the Family Interview. 6. In Facility and Provider Interview, delete the following questions 8, 32 (lst 9 items), 36, 40 h,i,j,k, 50, 51, 52, 66 d&e, 67, 68, 69. The Agency has agreed to: 1. Add a question to the Family Interview which will provide informa tion about why the residents were placed in institutions. 2. Add a question to Resident Assessment to address appropriate placement or need for another location. 3. Add a question to get an assessment of the degree of mobility of residens in these institutions. Since this survey is not based on a random sample, conclusions

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/1983	04/30/1983
Responses	7,500	0	0
Time Burden (Hours)	5,160	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: VIA DIRECT ON-SITE INTERVIEWS, THE DENVER RESEARCH INSTITUTE WILL ASSESS AND EVALUATE THE NEEDS AND CAPABILITIES OF THE MENTALLY ILL, MENTALLY RETARDED, AND ELDERLY LIVING IN AND CARE HOMES, INTERMEDIATE CARE FACILITIES, AND SINGLE ROOM OCCUPANCIES, WILL DETERMINE THE CONDITIONS UNDER WHICH THESE DISABLED POPULATIONS ARE LIVING IN THE COMMUNITY AND THE DEGREE TO WHICH STATES ARE IN FACT REGULATING THESE FACILITIES

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
EVALUATION OF BOARD AND CARE HOMES, INTERMEDIATE CARE FACILITIES, AND SINGLE ROOM OCCUPANCIES	OS-1-81

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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	7,500	0	0	7,500	0	0
Annual Time Burden (Hours)	5,160	0	0	5,160	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:

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

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

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]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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: 01/26/1981

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