The Effect of Reducing Falls on Acute and Long -Term Care Expenses

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
2007-02-27 Fall Prevention Phone Screening.pdf	Supporting Statement B	Uploaded 2007-03-09	Available
insurancecompAppendix H.doc	Supplementary Document	Uploaded 2006-11-09	Available
0990ActionPlanAppendix F.doc	Supplementary Document	Uploaded 2006-11-09	Repair queued
0990QuarterlyTelephoneAppendix G.doc	Supplementary Document	Uploaded 2006-11-09	Repair queued
SampleRecruitmentAppendix I.doc	Supplementary Document	Uploaded 2006-11-09	Available
Appendix C-REDUCING FALLS.pdf	Supplementary Document	Uploaded 2006-11-09	Repair queued
0990PhysicianReviewAppendix E.doc	Supplementary Document	Uploaded 2006-11-09	Available
0990HealthPromotionAppendix D.doc	Supplementary Document	Uploaded 2006-11-09	Available
0990telephoneriskAppendix B.doc	Supplementary Document	Uploaded 2006-11-09	Available
0990ModelFallPreventionAppendix A.doc	Supplementary Document	Uploaded 2006-11-09	Available
supportingstatementeffectof reducingfalls0990.doc	Supporting Statement A	Uploaded 2006-11-09	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
46272	Quarterly telephone calls-Field Test	Other-Other	New
46271	Jump Start phone call-Field Test	Other-Other	New
46270	Jump Start phone call-Field Test	Other-Other	New
46269	In person interview-Field Test	Other-Other	New
46268	Telephone screen	Other-Other	New
46267	Quarterly telephone calls	Other-Other	New
46266	Jump Start phone call	Other-Other	New
46265	In person Interview	Other-Other	New
46264	The Effects of Reducing Falls on Acute and Long-Term Care Expense	Other-Other	New

ICR Details

OMB Control No: 0990-0308	ICR Reference No: 200611-0990-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/HHSDM	Agency Tracking No:
Title: The Effect of Reducing Falls on Acute and Long -Term Care Expenses
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 03/12/2007
	Date Received in OIRA: 11/30/2006
Terms of Clearance: Approved consistent with changes and additional information detailed in CDC memos submitted to OMB.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2010	36 Months From Approved
Responses	9,870	0	0
Time Burden (Hours)	4,320	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: ASPE is planning to conduct a demonstration and evaluationm of a multi-factorial fall prevention program to measure its impact on health outcomes for the elderly as well as acute and long-term care use and cost. This will be accomplished by obtaining a sample of individualts with private long term care insurance who are age 75 and over. We will employ a multitiered random experimental research design to evaluate the effectiveness of the proposed fall prevention intervention program.

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Authorizing Statute(s): US Code: 42 USC 301 Name of Law: 241Public Health Service Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 13850	03/17/2006
30-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 62593	10/26/2006
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 9

table that charts list of burden

IC Title	Form No.	Form Name
Quarterly telephone calls
Telephone screen
In person interview-Field Test
Jump Start phone call-Field Test
Jump Start phone call-Field Test
Quarterly telephone calls-Field Test
The Effects of Reducing Falls on Acute and Long-Term Care Expense
In person Interview
Jump Start phone call

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ICR Summary of Burden

table that charts list of burden

	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	9,870	0	0	9,870	0	0
Annual Time Burden (Hours)	4,320	0	0	4,320	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: New collection

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Annual Cost to Federal Government: $1,000,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 11/09/2006

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