OMB control number

Older Adult Safe Mobility Assessment Tool

OMB 0920-1005 · HHS/CDC.

OMB 0920-1005

Latest forms, documents, and information collections
Document	Type
Follow-up Interview Guide	Form and Instruction
Mobility Planning Tool (MPT)	Form and Instruction
Baseline Interview	Form and Instruction
Screener Interview Guide (Acceptance)	Form and Instruction
Initial Screening (Refusal)	Form and Instruction
OAMAT-ATO-08-29-2016.pdf	Supplementary Document
Attach E PIA 2016.pdf	Supplementary Document
Attach C3d NCIPC Research Determination Form_1005 OlderAdult.pdf	Supplementary Document
Attach C3c_Analytic Plan and Illustrative Table Shells_1005 OlderAdult.doc	Supplementary Document
Attach C3b_follow-up Letter.docx	Supplementary Document
Attach C3a_Mobility Planning Tool.pdf	Supplementary Document
Attach C2 IRB Protocol_1005 OlderAdult.pdf	Supplementary Document
Attach C1_IRB approval letter 2016.pdf	Supplementary Document
Attach B1_NonSubs Comment.pdf	Supplementary Document
Attach B_60DyFRN2016.pdf	Supplementary Document
Attach A_Authorizing Legislation_1005 OlderAdult.docx	Supplementary Document
SSB_1005 OlderAdult_Exten ICRO_GB_9216.docx	Supporting Statement B
SSA_1005 OlderAdult_Exten_ICRO_9716.docx	Supporting Statement A
Follow-up Interview Guide	Form and Instruction
Mobility Planning Tool (MPT)	Form and Instruction
Baseline Interview	Form and Instruction
Screener Interview Guide (Acceptance)	Form and Instruction
Initial Screening (Refusal)	Form and Instruction

Historical document collections
Reference	Filing	Received	Action
201609-0920-002	Extension without change of a currently approved collection	2016-09-13	Approved without change
201511-0920-003	No material or nonsubstantive change to a currently approved collection	2015-11-12	Approved without change
201507-0920-013	Reinstatement with change of a previously approved collection	2015-08-05	Approved with change
201311-0920-013	New collection (Request for a new OMB Control Number)	2013-11-19	Approved without change