State Annual Long-Term Care Ombudsman Report

Forms and Documents

Document Name	Status
State Annual Long-Term Care Ombudsman Report Form and Instruction	Modified
0005 Response to Public Comments Aug 21.pdf Supplementary Document	2021-08-05
0005 Supporting Statement LTCOP Final Aug 21.pdf Supporting Statement A	2021-08-05

IC Document Collections

IC ID	Document Title	Status
10249	State Annual Long-Term Care Ombudsman Report Form and Instruction	Modified

ICR Details

OMB Control No: 0985-0005	ICR Reference No: 202108-0985-001
Status: Received in OIRA	Previous ICR Reference No: 201802-0985-003
Agency/Subagency: HHS/ACL	Agency Tracking No:
Title: State Annual Long-Term Care Ombudsman Report
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 08/10/2021

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	52	0
Time Burden (Hours)	11,153	0
Cost Burden (Dollars)	0	0

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Abstract: The State Annual Long-Term Care Ombudsman Report is needed to comply with Administration for Community Living/Administration on Aging (ACL/AoA) reporting requirements in the Older Americans Act (OAA); and 45 CFR §1324.21(b) (1) and (b)(2)(v). The long-term care ombudsman report is used to measure the services and strategies that are provided to assist residents in the protection of their health, safety, welfare or rights; advocate at the state and federal levels for changes needed to improve the quality of life and care in long-term care facilities; and effectively manage the Long-Term Care Ombudsman Program at the state and federal level. The National Ombudsman Reporting System (NORS) was developed in response to these needs and directives. Section 712(c) of the OAA requires the state agency to establish a statewide uniform reporting system to: (1) Collect and analyze data relating to resident complaints and conditions in long-term care facilities for the purpose of identifying and resolving significant problems. and (2) Submit the data on a regular basis to the state licensing/certifying agency, other state and federal entities that the Ombudsman determines to be appropriate, the Assistant Secretary for Aging, and the National Long-Term Care Ombudsman Resource Center.

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Authorizing Statute(s): US Code: 42 USC chapter 35 Name of Law: Programs for Older Americans
   PL: Pub.L. 109 - 365 712 (c),(h)(1)-(3) Name of Law: Older Americans Act
  

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 13720	03/10/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 40848	07/29/2021
Did the Agency receive public comments on this ICR? Yes

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

IC Title	Form No.	Form Name
State Annual Long-Term Care Ombudsman Report	NA, NA, NA	Table 1 ,   Table 2 ,   Table 3

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ICR Summary of Burden

	Total Request	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	52	0	0	52	0	0
Annual Time Burden (Hours)	11,153	0	0	11,153	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: There is a program change decrease of -475 annual burden hours.

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Annual Cost to Federal Government: $220,519

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

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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? No

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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: 08/10/2021

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