Prevention and Public Health Funds Evidence-Based Falls Prevention Program Information Collection

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Evidence-Based Falls Prevention Program (Project Staff)	Form and Instruction	Modified	Repair queued
Evidence-Based Falls Prevention Program (Local Respondents)	Form and Instruction	Modified	Missing upstream
Participant Information Forms	Form and Instruction	Modified	Missing upstream
0039 Public comment summary.pdf	Supplementary Document	Uploaded 2021-03-11	Repair queued
0039 Falls Prevention Supporting Statement - 2021 Final.pdf	Supporting Statement A	Uploaded 2021-03-11	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
213600	Evidence-Based Falls Prevention Program (Project Staff)	Form and Instruction	Modified
213599	Evidence-Based Falls Prevention Program (Local Respondents)	Form and Instruction	Modified
213597	Participant Information Forms	Form and Instruction	Modified

ICR Details

OMB Control No: 0985-0039	ICR Reference No: 202103-0985-001
Status: Received in OIRA	Previous ICR Reference No: 201801-0985-002
Agency/Subagency: HHS/ACL	Agency Tracking No:
Title: Prevention and Public Health Funds Evidence-Based Falls Prevention Program Information Collection
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 03/12/2021

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	03/31/2021
Responses	17,680	27,696
Time Burden (Hours)	2,888	4,344
Cost Burden (Dollars)	0	0

---

Abstract: The Administration on Aging (AoA), part of the Administration for Community Living (ACL), these data collection tools to monitor grantees receiving “Evidence-Based Falls Prevention Programs” cooperative agreements.” Grantee agencies through this program represent a variety of organization types, including state agencies, universities, and nonprofit organizations. Grantees are tasked with two primary goals: (1) significantly increase the number of older adults who participate in evidence-based falls prevention programs; and (2) develop a sustainable infrastructure for these proven interventions. ACL Falls Prevention grantees currently collect information at both the workshop and participant level. Specific to the workshop, information on workshop type, site type, location, start/end date, etc. is collected. At the participant level, de-identified demographic and health status information is collected prior to workshop participation. A sample of participants also completes a Post Program Survey to assess whether the program is achieving its intended outcomes, i.e., reducing falls risk factors and/or incidence. AoA funds a National Falls Prevention Resource Center(the “Center”) to provide technical assistance (TA) to ACL grantees as well as the broader network of organizations implementing evidence-based falls prevention programs. The Center developed a database, which grantees and other program sites use to provide data on their workshops. This system allows AoA regular monitoring of grantee performance status, including data analysis, maps, comparative charts, and identification of high- and low-performing grantees in order to identify and target TA needs. AoA uses the information from the PPHF Falls Prevention data collection tools to: 1) Comply with reporting requirements mandated by the authorizing statutes; 2) Collect data for performance measures used in the justification of the budget to Congress and by program, state, and national decision makers; 3) Effectively manage the Falls Prevention program at the federal, state, and local levels; 4) Identify program implementation issues and pinpoint areas for technical assistance activities; 5) Identify best practices in program implementation and building sustainable program delivery systems as well as develop resources to enable current and future grantees to learn from and replicate these practices; and 6) Provide information for reports to Congress, other governmental agencies, stakeholders, and to the public about PPHF Falls Prevention grantee progress.

---

Authorizing Statute(s): PL: Pub.L. 109 - 365 206 Name of Law: Evaluation
   PL: Pub.L. 113 - 76 218 Name of Law: Prevention and Public Health Fund Reporting
   PL: Pub.L. 109 - 365 411 Name of Law: Program Authorization
  

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:
	85 FR 60808	09/28/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 13904	03/11/2021
Did the Agency receive public comments on this ICR? Yes

---

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

table that charts list of burden

IC Title	Form No.	Form Name
Evidence-Based Falls Prevention Program (Local Respondents)	NA, NA, NA, NA, NA	Cover Sheet ,   Participant Information Form ,   Post Session Survey ,   Attendance Log ,   Host Information Form
Evidence-Based Falls Prevention Program (Project Staff)	NA	Falls Semi-Annual Progress Report
Participant Information Forms	NA, NA	Participant Form ,   Post Session Survey

---

ICR Summary of Burden

table that charts list of burden

	Total Request	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	17,680	27,696	0	-10,016	0	0
Annual Time Burden (Hours)	2,888	4,344	0	-1,456	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: There is a program change annual burden decrease of -1456 annual hours. ACL/AoA received the following feedback on the information collection: • National Falls Prevention Resource Center subject-matter experts • A grantee focus group (with less than 9 participants combined) • Public comments (during 60-day Federal Registrar period)

---

Annual Cost to Federal Government: $164,904

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Yes

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

---

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: 03/12/2021

---