Cost and Follow-up Assessment of Administration on Aging (AoA) - Funded Fall Prevention Programs for Older Adults

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Cost and Follow-up Assessment of Fall Prevention Programs	Form	New	Repair queued
Follow-up Assessment of Matter of Balance Programs	Form	New	Available
Screener for Follow-up Assessment of Matter of Balance Programs	Form	New	Available
Prelim sampling plan.pdf	Supplementary Document	Uploaded 2009-07-06	Available
CONSENT FORM MOB-CDC 1-27-09.doc	Supplementary Document	Uploaded 2009-07-06	Repair queued
Attachment 2 - Follow-up assessment questionnaire_01-16-09 (rev 7-1-09).doc	Supplementary Document	Uploaded 2009-07-06	Available
Final_supporting_statement_B[1].doc	Supporting Statement B	Uploaded 2009-07-06	Available
Attachment 5_ Cost and Foll UpPrevention_determination.pdf	Supplementary Document	Uploaded 2009-03-09	Available
Attachment 4_Federal Register notice_4-14-08.pdf	Supplementary Document	Uploaded 2009-03-09	Available
Attachment 1- Authorizing Legislation 12 01.doc	Supplementary Document	Uploaded 2009-03-09	Available
Final Supporting Statement A.doc	Supporting Statement A	Uploaded 2009-03-09	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
188659	Cost and Follow-up Assessment of Fall Prevention Programs	Form	New
188658	Follow-up Assessment of Matter of Balance Programs	Form	New
188657	Screener for Follow-up Assessment of Matter of Balance Programs	Form	New

ICR Details

OMB Control No: 0920-0818	ICR Reference No: 200904-0920-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Cost and Follow-up Assessment of Administration on Aging (AoA) - Funded Fall Prevention Programs for Older Adults
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: 07/24/2009
	Date Received in OIRA: 04/02/2009
Terms of Clearance: Approved consistent with modified and additional documents uploaded on 7/6/2009. CDC acknowledges that the case study design of the evaluation component limits generalizability of findings to broader populations. While the evaluation case study is likely to yield interesting results, it cannot be used to determine the overall effectiveness of the "Matter of Balance" program.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2010	12 Months From Approved
Responses	1,125	0	0
Time Burden (Hours)	744	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: NCIPC seeks to examine the cost of implementing each of three AoA-funded fall prevention programs for older adults and to assess the maintenance of fall prevention behaviors among participants 6 months after completing the Matter of Balance program. The interview will assess knowledge and self-efficacy related to falls as taught in the course, activity and exercise levels, and reported falls before and after the program. The cost assessment will calculate the lifecycle cost of the Stepping On, Moving for Better Balance, and Matter of Balance programs. The data will allow for comparison of program costs, and identification of cost drivers, risks, and attributes of each program.

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Authorizing Statute(s): US Code: 42 USC 301 Name of Law: Public Health Services 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:
	73 FR 20057	04/14/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 9616	03/05/2009
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
Follow-up Assessment of Matter of Balance Programs	none	Follow-up Assessment of Matter of Balance Programs
Cost and Follow-up Assessment of Fall Prevention Programs	none	Cost Assessment of Fall Prevention Programs
Screener for Follow-up Assessment of Matter of Balance Programs	none	Screener for Follow-up Assessment

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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	1,125	0	0	1,125	0	0
Annual Time Burden (Hours)	744	0	0	744	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: This is a new ICR.

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Annual Cost to Federal Government: $132,476

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? Yes

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)? No

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: 04/02/2009

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