Information Collection

CDC Older Adult Injury Prevention Creative Campaign - Survey

IC 252627 under ICR 202108-0920-006 · OMB 0920-0572.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0572 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-22EC Attachment 1_Still Going Strong 2021-2022 Survey Questions 1.19.22 (002) CDC Older Adult Injury Prevention Creative Campaign - Survey	Form and Instruction
0920-22EC Attachment 1_Still Going Strong 2021-2022 Survey Questio Attachment 1_Still Going Strong 2021-2022 Survey Questions 1.19.22 (002).docx	Form and Instruction
1. Older Adults_HMTSExpedited Review Form.pdf 1. Older Adults_HMTSExpedited Review Form	IC Document
Attachment 1a_Survey ScreenShots.docx Attachment 1a_Survey ScreenShots	IC Document
Project Description_CDC Older Adult Injury Prevention Creative Campaign_1.24.2022.docx Project Description_CDC Older Adult Injury Prevention Creative Campaign	IC Document

IC Title:

CDC Older Adult Injury Prevention Creative Campaign - Survey

Agency IC Tracking Number:

0920-22EC

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
Form and Instruction	0920-22EC				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	84	84
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
1. Older Adults_HMTSExpedited Review Form		04/05/2022
Attachment 1a_Survey ScreenShots		04/05/2022
Project Description_CDC Older Adult Injury Prevention Creative Campaign		04/05/2022

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

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