83-c

Paperwork Reduction Act

Change Worksheet

Agency/Subagency: U.S. Department of Housing and Urban Development			OMB Control Number: 2528-0335
Enter only items that change		Current Record		New Record**
Agency form number(s):      		     		     
Annual reporting and keeping hour burden
	Number of respondents	     		     
	Total annual responses	     		     
	Percent of these responses collected electronically	    %		    %
	Total annual hours	     		     
	Difference			     
	Explanation of difference Program change Adjustment			           
Annual reporting and recordkeeping cost burden (in thousands of dollars)
	Total annualized Capital/Startup costs	     		     
	Total annual costs (O&M)	     		     
	Total annualized cost requested	     		     
	Difference			     
	Explanation of difference Program change Adjustment			           

Other change: **

This submission includes a series of non-substantive changes to the instruments to be administered as part of the evaluation of the second cohort of HUD’s Older Adult Home Modification Program. Recommended revisions are based on feedback from OAHMP grantees (cohort 1) and findings from comparisons of the Centers for Medicaid and Medicare Health Outcomes Survey (HOS), the Johns Hopkins University National Health and Aging Trends Study (NHATS), and the University of Michigan Health and Retirement Study (HRS) datasets. Revisions include:

1. edits to clarify questions,

2. relocating questions between forms to reduce the burden on the occupational therapists (OTs) who – in many instances – are not internal grantee staff,

3. splitting or providing “follow-up” question(s) to help clarify client response(s), and

4. reframing the wording of questions to better align with NHATS and/or HRS.

Although the number of questions in some DCIs did not increase nor decrease, Solutions may have reduced or increased response options to conform to options included in the NHATS or HRS, e.g. the original form may have specified numerous options for Hispanic but the revised form asks the question as a yes or no option; or original options were “yes,” “no,” or “unable”, but the revised form provides additional option of “don’t know” or enables grantee to mark “refused to answer.” Solutions revisions reduce the overall number of questions for all DCIs from 278 to 274.

Proposed Edits to Instruments for the Older Adult Home Modification Evaluation – Cohort

Data Collection Instruments	# of Questions		Reason(s) for Revision/Change
	Original	Revised
Client Eligibility (Appendix B)
	18	22	Moved demographic/socio-economic questions from Client Impact Evaluation to Client Eligibility to reduce OT burden
Total DCI Questions	18	22
Client Program Questionnaire (Appendix C)
Section A	8	8	No change
Section B	8	8	No change
Section C	10	10	No change
Section D	7	9	Added questions to distinguish between fall and non-fall injuries
Total DCI Questions	33	35
Home Hazard Checklist (Appendix D)
Section A	22	22	No change
Section B	6	6	No change
Section C	4	4	No change
Section D	9	9	No change
Section E	9	9	No change
Section F	11	11	No change
Section G	15	16	Added a follow-up question to clarify which bathroom(s) client regularly uses (requested by grantees)
Section H	8	8	No change
Section I	10	10	No Change.
Section J	3	3	No change.
Total DCI Questions	97	98
Informed Consent (Appendix E)
	3	3	No change
Total DCI Questions	3	3
Client Impact Evaluation Interview (Appendix F)
Section A	1	1	No change
Section B	9	4	No change
Section C	19	19	No change
Section D	6	6	No change
Section E	15	9	Reduced or collapsed questions to enable additional questions in Sec G and H
Section F	10	4	Questions moved to Client Eligibility form
Section G	6	9	Added questions to distinguish between fall and non-fall injuries
Section H	3	7	Added questions to distinguish between fall and non-fall injuries
Section I (Optional)	4	4	No change
Total DCI Questions	73	63
Lost to Project Form (Appendix G)
Introduction	1	1	No change
Section A	1	1	No change
Section B	1	1	No change
Total DCI Questions	3	3
Documentation of Completed Work (Appendix H)
REDCap	6	5	Dropped one question.
Excel Spreadsheet	11	11	Rearranged but did not otherwise change. These are the min number of entries (total # is based on number of sources and modifications/ adaptive equip provided to client, no increase in the number of questions between the original and revised versions). Majority of responses are provided in dropdown based on NOFO's Appendix B.
Total DCI Questions	17	16
Annual Grantee Process Survey (Appendix I)
	17	17	Plus 2 optional questions on both
Total DCI Questions	17	17
Grantee Site Visit Interview (Appendix J)
	12	12	Edited and rearranged questions based on field experience. Although overall number of questions remains the same - additional follow-up questions for clarification if needed.
Total DCI Questions	12	12
Script to Schedule Client Process Interview (Appendix K)
	5	5	No change
Total DCI Questions	5	5
Client Process Survey Interview (Appendix L)
	27	27	No change
Total DCI Questions	27	27
TOTAL (ALL DCIs)	278	274

Signature of Senior Official or Designee: X

Date:

For OIRA Use

** This form cannot be used to extend an expiration date.

OMB 83-C 10/95