Information Collection Request

Evaluation of the Older Adults Home Modification Grant Program

ICR 202207-2528-003 · OMB 2528-0335 · Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
omb83-c. 2528-0335.pdf Justification for No Material/Nonsubstantive Change Uploaded 2022-07-20 Available
Final- EOAHMO ICR Supporting Statement_PDR.Final_PART_A.docx Supporting Statement A Uploaded 2022-01-03 Available
Appendix A. 12 U.S. Code § 1701z6_OAHM_Final.docx Supplementary Document Uploaded 2021-12-16 Available
30-Day Notice Evaluation of the Older Adults Home Modification Grant Program.pdf Supplementary Document Uploaded 2021-12-16 Available
60-Day Notice Evaluation of the Older Adults Home Modification Grant Program.pdf Supplementary Document Uploaded 2021-12-16 Available
Final - EOAHMO ICR Supporting Statement_PDR.Final_PART.B.docx Supporting Statement B Uploaded 2021-12-16 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
254748 Grantee Site Visit Interview Guide Other-Grantee Site Visit Interview Guide New
254747 Grantee Process Evaluation Online Survey Year 1 Other-Grantee Process Evaluation Online Survey Year 1 New
254746 OAHM Program Documentation of Work Completed Form Other-OAHM Program Documentation of Work Completed Form New
254745 Lost-to-Project Form Other-Lost-to-Project Form New
254744 Client Eligibility Documentation Form Other-Client Eligibility Documentation Form New
250824 Client Process Evaluation Interview Other-Client Process Evaluation Interview Modified
250823 Script to Schedule Client Process Evaluation Interview Other-Script to Schedule Client Process Evaluation Interview Modified
250822 OAHM Client Impact Evaluation Interview (Post-modification) Other-OAHM Client Impact Evaluation Interview (Post-modification Modified
250821 OAHM Client Impact Evaluation Interview (Baseline) Other-OAHM Client Impact Evaluation Interview (Baseline) Modified
250820 Home Hazard Checklist (Post-modification) Other-Home Hazard Checklist (Post-modification) Modified
250819 Home Hazard Checklist (Baseline) Other-Home Hazard Checklist (Baseline) Unchanged
250817 OAHM Program Evaluation Informed Consent Other-OAHM Program Evaluation Informed Consent Modified
250816 OAHM Client Program Questionnaire (Post-modification) Other-OAHM Client Program Questionnaire (Post-modification) Modified
250815 OAHM Client Program Questionnaire (Baseline) Other-OAHM Client Program Questionnaire (Baseline) Unchanged

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
05/31/2025 05/31/2025 05/31/2025
25,481 0 15,921
6,255 0 4,401
0 0 0





table that charts list of burden
  Total Approved 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 25,481 15,921 0 9,560 0 0
Annual Time Burden (Hours) 6,255 4,401 0 1,854 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No