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 202202-0920-003 · 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 Modified Repair queued
Form 0920-19ARD Consent Form Form and Instruction Unchanged Repair queued
Follow-up Survey Form and Instruction Unchanged Repair queued
Baseline Survey Form and Instruction Unchanged Repair queued
Change Request for OMB no. 0920-1281_02102022.docx Justification for No Material/Nonsubstantive Change Uploaded 2022-02-10 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 Repair queued
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 Missing upstream
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 Missing upstream
SSB STEADI eval primary care _10_9_19.docx Supporting Statement B Uploaded 2019-10-16 Repair queued
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 Modified
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 202202-0920-003
Received in OIRA 202108-0920-010
HHS/CDC 0920-1281
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 02/11/2022
  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 to add an incentive for physicians to participate in qualitative interviews and does not include changes to the currently approved burden and/or costs to the public. CDC is also correcting a typographical error in the burden advisory statement on this form.
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
Renita Macaluso 770 488-6458 [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.
02/11/2022