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	Modified	Available
Follow-up Assessment of Matter of Balance Programs	Form	Modified	Available
Screener for Follow-up Assessment of Matter of Balance Programs	Form	Modified	Available
Supporting_Statement_Part_B_1 27 10.doc	Supporting Statement B	Uploaded 2010-02-10	Available
FedRegister_9-4-09.pdf	Supplementary Document	Uploaded 2010-03-01	Available
CONSENT FORM 0920-0818 MOB-CDC 02-2010.doc	Supplementary Document	Uploaded 2010-02-10	Available
Attachment_5__Cost_and_Foll_UpPrevention_determination.pdf	Supplementary Document	Uploaded 2010-02-10	Available
Prelim_sampling_plan.pdf	Supplementary Document	Uploaded 2010-02-10	Available
Attachment_4_Federal_Register_notice_4-14-08.pdf	Supplementary Document	Uploaded 2010-02-10	Available
Attachment_1-_Authorizing_Legislation_12_01.doc	Supplementary Document	Uploaded 2010-02-10	Available
Supporting_Statement_Part_A_Extension02.24.10.docx	Supporting Statement A	Uploaded 2010-02-25	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	Modified
188658	Follow-up Assessment of Matter of Balance Programs	Form	Modified
188657	Screener for Follow-up Assessment of Matter of Balance Programs	Form	Modified

ICR Details

OMB Control No: 0920-0818	ICR Reference No: 201003-0920-004
Status: Historical Active	Previous ICR Reference No: 200904-0920-002
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: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/05/2010
	Date Received in OIRA: 03/10/2010
Terms of Clearance: 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	04/30/2013	36 Months From Approved	07/31/2010
Responses	375	0	1,125
Time Burden (Hours)	247	0	744
Cost Burden (Dollars)	0	0	0

---

Abstract: CDC requests a 3 year extension to collect data for the Cost and Follow-up Assessment of Fall Prevention Programs. CDC seeks to examine the cost of implementing each of three Administration on Aging-Funded Fall Prevention Programs for older adults - Stepping On, Moving for Better Balance and Matter of Balance, and the extent to which preventive behaviors are maintained. CDC initially assessed these programs in one year, and requests an extension to continue assessment over 3 years.

---

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

Citations for New Statutory Requirements: None

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 45861	09/04/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 6671	02/10/2010
Did the Agency receive public comments on this ICR? No

---

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

table that charts list of burden

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

---

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	375	1,125	0	0	-750	0
Annual Time Burden (Hours)	247	744	0	0	-497	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government: $131,343

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)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  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:

(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: 03/10/2010

---