OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

GenIC "Primary Care Provider - Stopping Elderly Accidents, Deaths, and Injuries (STEADI)"

IC 224152 under ICR 201405-0920-002 · OMB 0920-1009.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Att A_Recruiting Scripts.docx Other-WORD
Att B_Focus Group Moderator Guide.docx Other-WORD
Att C_Phone Interview Script.docx Other-WORD
Att D_Steadi Flyer-Primary Care.pdf
Steadi Flyer_Primary Care		IC Document
GenIC_Request_STEADI_102616.docx
Request for Approval		IC Document

Information Collection (IC) Details

View Information Collection (IC)

layout table

Information Collection Instruments:
table that charts list of instruments
Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-WORD Att A_Recruiting Scripts.docx No   Fillable Fileable
Other-WORD Att B_Focus Group Moderator Guide.docx No   Fillable Fileable
Other-WORD Att C_Phone Interview Script.docx No   Fillable Fileable

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 182 0 182 0 0 0
Annual IC Time Burden (Hours) 73 0 73 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Documents for IC
table that charts IC Documents
Title Document Date Uploaded
Steadi Flyer_Primary Care Att D_Steadi Flyer-Primary Care.pdf 10/26/2016
Request for Approval GenIC_Request_STEADI_102616.docx 10/27/2016
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.