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 202108-0920-010 · OMB 0920-1281 · Received in OIRA

Forms and Documents
DocumentTypeStatusAvailability
Form 0920-19ARD Operations Manager Interivew Form and Instruction Unchanged Repair queued
Provider Interview Guide Form and Instruction Unchanged Available
Form 0920-19ARD Consent Form Form and Instruction Unchanged Repair queued
Follow-up Survey Form and Instruction Unchanged Missing upstream
Baseline Survey Form and Instruction Unchanged Repair queued
Change Request OMB-0920-1281 STEADI Cost Effectiveness.docx Justification for No Material/Nonsubstantive Change Uploaded 2021-08-16 Repair queued
Crosswalk OMB#0920_1281.xlsx Supplementary Document Uploaded 2020-07-15 Repair queued
Change Request STEADI Cost Effectiveness 7_1_20 .docx Justification for No Material/Nonsubstantive Change Uploaded 2020-07-15 Missing upstream
Final Change Request STEADI Cost Effectiveness 4-7-2020.docx Justification for No Material/Nonsubstantive Change Uploaded 2020-04-09 Repair queued
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 Repair queued
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 Missing upstream
SSA STEADI eval primary care_ 10_9_19 final.docx Supporting Statement A Uploaded 2019-10-16 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
238165 Operations Manager Interivew Form and Instruction Unchanged
238164 Provider Interview Guide Form and Instruction Unchanged
238163 Consent Form Form and Instruction Unchanged
238161 Follow-up Survey Form and Instruction Unchanged
238160 Baseline Survey Form and Instruction Unchanged
ICR Details
0920-1281 202108-0920-010
Received in OIRA 202007-0920-011
HHS/CDC 0920-1281-21HF
Evaluation of CDC’s STEADI Older Adult Fall Prevention Initiative in a Primary Care Setting
No material or nonsubstantive change to a currently approved collection   No
Regular 08/16/2021
  Requested Previously Approved
01/31/2023 01/31/2023
4,928 4,928
1,174 1,174
0 0
This Non-Substantive change request is related to the ICR entitled, “Evaluation of CDC’s STEADI Older Adult Fall Prevention Initiative in a Primary Care Setting,” OMB control number 0920-1281. This Non-Substantive change request is to modify the incentive provided for the baseline and follow-up patient surveys and does not include changes to the currently approved burden and/or costs to the public.
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 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 4,928 4,928 0 0 0 0
Annual Time Burden (Hours) 1,174 1,174 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$373,562
Yes Part B of Supporting Statement
    Yes
    No
No
No
No
No
Thelma Sims 4046394771
  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.
08/16/2021