OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Cost and Follow-up Assessment of Administration on Aging (AoA) - Funded Fall Prevention Programs for Older Adults

ICR 200904-0920-002 · OMB 0920-0818 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Cost and Follow-up Assessment of Fall Prevention Programs Form New Repair queued
Follow-up Assessment of Matter of Balance Programs Form New Available
Screener for Follow-up Assessment of Matter of Balance Programs Form New Available
Prelim sampling plan.pdf Supplementary Document Uploaded 2009-07-06 Available
CONSENT FORM MOB-CDC 1-27-09.doc Supplementary Document Uploaded 2009-07-06 Repair queued
Attachment 2 - Follow-up assessment questionnaire_01-16-09 (rev 7-1-09).doc Supplementary Document Uploaded 2009-07-06 Available
Final_supporting_statement_B[1].doc Supporting Statement B Uploaded 2009-07-06 Available
Attachment 5_ Cost and Foll UpPrevention_determination.pdf Supplementary Document Uploaded 2009-03-09 Available
Attachment 4_Federal Register notice_4-14-08.pdf Supplementary Document Uploaded 2009-03-09 Available
Attachment 1- Authorizing Legislation 12 01.doc Supplementary Document Uploaded 2009-03-09 Available
Final Supporting Statement A.doc Supporting Statement A Uploaded 2009-03-09 Available
IC Document Collections
IC IDCollectionTypeStatusForm
188659 Cost and Follow-up Assessment of Fall Prevention Programs Form New
188658 Follow-up Assessment of Matter of Balance Programs Form New
188657 Screener for Follow-up Assessment of Matter of Balance Programs Form New
ICR Details
0920-0818 200904-0920-002
Historical Active
HHS/CDC
Cost and Follow-up Assessment of Administration on Aging (AoA) - Funded Fall Prevention Programs for Older Adults
New collection (Request for a new OMB Control Number)   No
Regular
Approved with change 07/24/2009
Retrieve Notice of Action (NOA) 04/02/2009
Approved consistent with modified and additional documents uploaded on 7/6/2009. CDC acknowledges that the case study design of the evaluation component limits generalizability of findings to broader populations. While the evaluation case study is likely to yield interesting results, it cannot be used to determine the overall effectiveness of the "Matter of Balance" program.
  Inventory as of this Action Requested Previously Approved
07/31/2010 12 Months From Approved
1,125 0 0
744 0 0
0 0 0
NCIPC seeks to examine the cost of implementing each of three AoA-funded fall prevention programs for older adults and to assess the maintenance of fall prevention behaviors among participants 6 months after completing the Matter of Balance program. The interview will assess knowledge and self-efficacy related to falls as taught in the course, activity and exercise levels, and reported falls before and after the program. The cost assessment will calculate the lifecycle cost of the Stepping On, Moving for Better Balance, and Matter of Balance programs. The data will allow for comparison of program costs, and identification of cost drivers, risks, and attributes of each program.
US Code: 42 USC 301 Name of Law: Public Health Services Act
  
None
Not associated with rulemaking
  73 FR 20057 04/14/2008
74 FR 9616 03/05/2009
No
  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 1,125 0 0 1,125 0 0
Annual Time Burden (Hours) 744 0 0 744 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a new ICR.
$132,476
Yes Part B of Supporting Statement
Yes
Uncollected
Uncollected
No
Uncollected
Maryam Daneshvar 4046394604
  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
04/02/2009