OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Evaluation of CDC’s STEADI Older Adult Fall Prevention Initiative in a Primary Care Setting

ICR 201910-0920-004 · OMB 0920-1281 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form 0920-19ARD Operations Manager Interivew Form and Instruction New Available
Form 0920-19ARD Provider Interview Guide Form and Instruction New Available
Form 0920-19ARD Consent Form Form and Instruction New Repair queued
Form 0920-19ARD Stay Independent Fall Risk Screener Form and Instruction New Repair queued
Form 0920-19ARD Follow-up Survey Form and Instruction New Repair queued
Form 0920-19ARD Baseline Survey Form and Instruction New Available
Att J_ Falls Tracking Log.docx Supplementary Document Uploaded 2019-10-16 Repair queued
Att I_ Illustrative table shells.xlsx Supplementary Document Uploaded 2019-10-16 Available
Att H_ IRB letter.pdf Supplementary Document Uploaded 2019-10-16 Repair queued
Att G Privacy Impact Assessment.pdf Supplementary Document Uploaded 2019-10-16 Repair queued
Att F _ 60 day FRN STEADI Eval.pdf Supplementary Document Uploaded 2019-10-16 Repair queued
Att A_ Authorizing Legislation.docx Supplementary Document Uploaded 2019-10-16 Available
SSB STEADI eval primary care _10_9_19.docx Supporting Statement B Uploaded 2019-10-16 Available
SSA STEADI eval primary care_ 10_9_19 final.docx Supporting Statement A Uploaded 2019-10-16 Available
IC Document Collections
IC IDCollectionTypeStatusForm
238165 Operations Manager Interivew Form and Instruction New
238164 Provider Interview Guide Form and Instruction New
238163 Consent Form Form and Instruction New
238162 Stay Independent Fall Risk Screener Form and Instruction New
238161 Follow-up Survey Form and Instruction New
238160 Baseline Survey Form and Instruction New
ICR Details
0920-1281 201910-0920-004
Historical Active
HHS/CDC 0920-19ARD
Evaluation of CDC’s STEADI Older Adult Fall Prevention Initiative in a Primary Care Setting
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 01/06/2020
Retrieve Notice of Action (NOA) 10/29/2019
Approved consistent with the understanding that CDC will not be conducting any general research on the information collected. When communicating findings from this collection, all publications will clearly describe the scope and limitations of the study findings.
  Inventory as of this Action Requested Previously Approved
01/31/2023 36 Months From Approved
8,963 0 0
1,578 0 0
0 0 0
The goal of this study is to evaluate CDC's Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative in a primary care setting. This formative evaluation will determine the impact of both the comprehensive and selected components of STEADI on falls and fall injuries. The data collected from this study will be used to: (1) demonstrate the impact of STEADI and different components of STEADI on falls and fall injuries in a primary care setting and (2) improve the implementation of STEADI in a primary care setting.
US Code: 42 USC 241 Name of Law: Public Health Service Act
  
None
Not associated with rulemaking
  84 FR 24150 05/24/2019
84 FR 57434 10/25/2019
Yes
  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 8,963 0 0 8,963 0 0
Annual Time Burden (Hours) 1,578 0 0 1,578 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a new collection.
$373,562
Yes Part B of Supporting Statement
    Yes
    No
No
No
No
Uncollected
Kevin Joyce 404 639-1944 [email protected]
  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.
10/29/2019