Information Collection

Stopping Elderly Accidents, Deaths, and Injuries (STEADI) - Focus Groups

IC 221538 under ICR 201405-0920-002 · OMB 0920-1009.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1009 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Stopping Elderly Accidents, Deaths, and Injuries (STEADI) - Focus Groups	Form and Instruction
Recruitment Screening Phone Script Att C Recruitment Screening phone scripts.docx	Form and Instruction
STEADI Focus Group Moderator Guide 18MAY2016 Att E Instrument STEADI Moderators Guide.docx	Form and Instruction
STEADI Phone Interview Moderator Guide 18MAY2016 Att F Phone Instrument STEADI Moderators Guide.docx	Form and Instruction
Att A Final SAFE.pdf SAFE Medication Review Framework	IC Document
Att B Steadi Flyer.pdf Pharmacist Focus Group Flyer	IC Document
Att D Confirmation call.docx Confirmatioin Call Script	IC Document
GenIC_Request_STEADI_051816ICRO.docx GenIC Request	IC Document

IC Title:

Stopping Elderly Accidents, Deaths, and Injuries (STEADI) - Focus Groups

Agency IC Tracking Number:

16AKU

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Electronic Capability
Form and Instruction	NA	Recruitment Screening Phone Script	Att C Recruitment Screening phone scripts.docx	NA	No	Fillable Printable
Form and Instruction	NA	STEADI Focus Group Moderator Guide 18MAY2016	Att E Instrument STEADI Moderators Guide.docx	NA	No	Fillable Printable
Form and Instruction	NA	STEADI Phone Interview Moderator Guide 18MAY2016	Att F Phone Instrument STEADI Moderators Guide.docx	NA	No	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 270

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	270	270
Annual IC Time Burden (Hours)	140	140
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SAFE Medication Review Framework	Att A Final SAFE.pdf	05/16/2016
Pharmacist Focus Group Flyer	Att B Steadi Flyer.pdf	05/16/2016
Confirmatioin Call Script	Att D Confirmation call.docx	05/16/2016
GenIC Request	GenIC_Request_STEADI_051816ICRO.docx	05/18/2016

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.