OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Evaluating the implementation and impact of an opioid medication management program, in a hospital discharge setting, to reduce falls in older adults

ICR 201910-0920-007 · OMB 0920-1285 · Active

Forms and Documents
DocumentTypeStatusAvailability
PCP post-discharge survey Form New Available
Clinical staff questionnaire Form New Repair queued
Post-discharge Patient Questionnaire Form New Available
Pre-discharge patient questionnaire Form New Available
POMI-test-article.pdf Supplementary Document Uploaded 2020-02-10 Available
SAMHSA email.pdf Supplementary Document Uploaded 2020-02-10 Repair queued
NCHS email.pdf Supplementary Document Uploaded 2020-02-10 Repair queued
Crosswalk Post Patient Survey Questions.docx Supplementary Document Uploaded 2020-02-10 Available
Crosswalk Pre Patient Survey Questions.docx Supplementary Document Uploaded 2020-02-10 Available
Attachment H Patient Consent Form .docx Supplementary Document Uploaded 2019-10-21 Available
Attachment G3 Correspondence to primary care providers.docx Supplementary Document Uploaded 2019-10-21 Repair queued
Attachment G2 Correspondence to UCSF clinical staff.docx Supplementary Document Uploaded 2019-10-21 Available
Attachment G1 Correspondence to patients.docx Supplementary Document Uploaded 2019-10-21 Available
Attachment F1. Illustrative table shells.xlsx Supplementary Document Uploaded 2019-10-21 Repair queued
Attachment D IRB_Approval letter.pdf Supplementary Document Uploaded 2019-10-21 Repair queued
Attachment C PIA.pdf Supplementary Document Uploaded 2019-10-21 Repair queued
Attachment B 60 day FRN.pdf Supplementary Document Uploaded 2019-10-21 Available
Attachment A Authorizing Legislation.docx Supplementary Document Uploaded 2019-10-21 Available
SSB_Evaluating implementation fall prevention program 10.9.19.docx Supporting Statement B Uploaded 2019-10-21 Available
SSA_Evaluating implementation fall prevention program_10.21.19.docx Supporting Statement A Uploaded 2019-10-21 Available
IC Document Collections
IC IDCollectionTypeStatusForm
238232 PCP post-discharge survey Form New
238231 Clinical staff questionnaire Form New
238230 Post-discharge Patient Questionnaire Form New
238229 Pre-discharge patient questionnaire Form New
ICR Details
0920-1285 201910-0920-007
Active
HHS/CDC 0920-19GH
Evaluating the implementation and impact of an opioid medication management program, in a hospital discharge setting, to reduce falls in older adults
New collection (Request for a new OMB Control Number)   No
Regular
Approved with change 02/11/2020
Retrieve Notice of Action (NOA) 11/21/2019
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. CDC/NCIPC will continue to consult and work closely with SAMHSA and CDC/NCHS to harmonize opioid related data collections.
  Inventory as of this Action Requested Previously Approved
02/28/2023 36 Months From Approved
3,300 0 0
541 0 0
12,997 0 0
The goal of this data collection is to conduct a formative evaluation to inform CDC of best practices for implementation of a fall prevention program into the hospital discharge process targeting opioid prescribing and management.
US Code: 42 USC 241 Name of Law: PHSA
  
None
Not associated with rulemaking
  84 FR 2520 02/07/2019
84 FR 64078 11/20/2019
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 3,300 0 0 3,300 0 0
Annual Time Burden (Hours) 541 0 0 541 0 0
Annual Cost Burden (Dollars) 12,997 0 0 12,997 0 0
Yes
Miscellaneous Actions
No
This is a new ICR.
$66,313
Yes Part B of Supporting Statement
    Yes
    Yes
No
No
No
Uncollected
Shari Steinberg 404 639-4942 [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.
11/21/2019