Information Collection Request

Evaluation of the Older Adults Home Modification Grant Program

ICR 202108-2528-001 · OMB 2528-0335 · Received in OIRA

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Final- EOAHMO ICR Supporting Statement_PDR.Final_PART_A.docx Supporting Statement A Uploaded 2022-01-03 Repair queued
Appendix J. Grantee Site Visit Interview Guide_OAHM Form_Final.docx Supplementary Document Uploaded 2021-12-16 Repair queued
Appendix I. Grantee Process Evaluation Online Survey Form_OAHM_Final.docx Supplementary Document Uploaded 2021-12-16 Repair queued
Appendix H. OAHM Program Documentation of Work Completed Form_OAHM_Final.docx Supplementary Document Uploaded 2021-12-16 Repair queued
Appendix G. Lost-to-Project Form_OAHM_Final.docx Supplementary Document Uploaded 2021-12-16 Repair queued
Appendix B. Client Eligibility Documentation Form_OAHM_Final.docx Supplementary Document Uploaded 2021-12-16 Repair queued
Appendix A. 12 U.S. Code § 1701z6_OAHM_Final.docx Supplementary Document Uploaded 2021-12-16 Repair queued
30-Day Notice Evaluation of the Older Adults Home Modification Grant Program.pdf Supplementary Document Uploaded 2021-12-16 Repair queued
60-Day Notice Evaluation of the Older Adults Home Modification Grant Program.pdf Supplementary Document Uploaded 2021-12-16 Repair queued
Final - EOAHMO ICR Supporting Statement_PDR.Final_PART.B.docx Supporting Statement B Uploaded 2021-12-16 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
250824 Client Process Evaluation Interview Other-Client Process Evaluation Interview New
250823 Script to Schedule Client Process Evaluation Interview Other-Script to Schedule Client Process Evaluation Interview New
250822 OAHM Client Impact Evaluation Interview (Post-modification) Other-OAHM Client Impact Evaluation Interview (Post-modification New
250821 OAHM Client Impact Evaluation Interview (Baseline) Other-OAHM Client Impact Evaluation Interview (Baseline) New
250820 Home Hazard Checklist (Post-modification) Other-Home Hazard Checklist (Post-modification) New
250819 Home Hazard Checklist (Baseline) Other-Home Hazard Checklist (Baseline) New
250817 OAHM Program Evaluation Informed Consent Other-OAHM Program Evaluation Informed Consent New
250816 OAHM Client Program Questionnaire (Post-modification) Other-OAHM Client Program Questionnaire (Post-modification) New
250815 OAHM Client Program Questionnaire (Baseline) Other-OAHM Client Program Questionnaire (Baseline) New

ICR Details

Reginfo record details
table that charts list comparision
  Requested Previously Approved
36 Months From Approved
15,921 0
4,401 0
0 0





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 15,921 0 0 15,921 0 0
Annual Time Burden (Hours) 4,401 0 0 4,401 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No