Information Collection

Stopping Elderly Accidents, Deaths, and Injuries (STEADI) in a Hospital Discharge Setting

IC 230187 under ICR 201612-0920-007 · OMB 0920-1009.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment C –Falls Prevention Participant Survey.docx	Other-WORD
Attachment B_Invitation Correspondence.docx	Other-WORD
Att. A Privacy Act.pdf Att A_D Intellix Award email (Privacy Determination)	IC Document
GenIC_Request_STEADI Hospital Discharge Setting.docx Request for Approval (0920-1005)	IC Document

IC Title:

Agency IC Tracking Number:

0920-1009 (18KW)

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?	Can Be Submitted Electronically?	Electronic Capability
Other-WORD			Attachment C âFalls Prevention Participant Survey.docx		Yes	Yes	Paper Only
Other-WORD			Attachment B_Invitation Correspondence.docx		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,532

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

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	1,532	1,532
Annual IC Time Burden (Hours)	104	104
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att A_D Intellix Award email (Privacy Determination)	Att. A Privacy Act.pdf	02/20/2018
Request for Approval (0920-1005)	GenIC_Request_STEADI Hospital Discharge Setting.docx	02/20/2018

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