Evaluation of CDC’s STEADI Older Adult Fall Prevention Initiative in a Primary Care Setting

OMB 0920-1281

The goal of this study is to evaluate CDC's Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative in a primary care setting. This formative evaluation will determine the impact of both the comprehensive and selected components of STEADI on falls and fall injuries. The data collected from this study will be used to: (1) demonstrate the impact of STEADI and different components of STEADI on falls and fall injuries in a primary care setting and (2) improve the implementation of STEADI in a primary care setting. This change request is to allow for virtual survey responses due to COVID restrictions.

The latest form for Evaluation of CDC’s STEADI Older Adult Fall Prevention Initiative in a Primary Care Setting expires 2023-01-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form 0920-19ARD Operations Manager Interivew Form and Instruction
Provider Interview Guide Form and Instruction
Form 0920-19ARD Consent Form Form and Instruction
Follow-up Survey Form and Instruction
Baseline Survey Form and Instruction
Change Request for OMB no. 0920-1281_02102022.docx Justification for No Material/Nonsubstantive Change
Change Request OMB-0920-1281 STEADI Cost Effectiveness.docx Justification for No Material/Nonsubstantive Change
Crosswalk OMB#0920_1281.xlsx Supplementary Document
Change Request STEADI Cost Effectiveness 7_1_20 .docx Justification for No Material/Nonsubstantive Change
Final Change Request STEADI Cost Effectiveness 4-7-2020.docx Justification for No Material/Nonsubstantive Change
Att J_ Falls Tracking Log.docx Supplementary Document
Att I_ Illustrative table shells.xlsx Supplementary Document
Att H_ IRB letter.pdf Supplementary Document
Att G Privacy Impact Assessment.pdf Supplementary Document
Att F _ 60 day FRN STEADI Eval.pdf Supplementary Document
Att A_ Authorizing Legislation.docx Supplementary Document
SSB STEADI eval primary care _10_9_19.docx Supporting Statement B
SSA STEADI eval primary care_ 10_9_19 final.docx Supporting Statement A
Operations Manager Interivew Form and Instruction
Provider Interview Guide Form and Instruction
Consent Form Form and Instruction
Follow-up Survey Form and Instruction
Baseline Survey Form and Instruction

All Historical Document Collections

202202-0920-003 Approved with change	No material or nonsubstantive change to a currently approved collection	2022-02-11
202108-0920-010 Approved without change	No material or nonsubstantive change to a currently approved collection	2021-08-16
202007-0920-011 Approved without change	No material or nonsubstantive change to a currently approved collection	2020-07-15
202004-0920-007 Approved without change	No material or nonsubstantive change to a currently approved collection	2020-04-09
201910-0920-004 Approved without change	New collection (Request for a new OMB Control Number)	2019-10-29

OMB Details

Baseline Survey

Federal Enterprise Architecture: Health - Public Health Monitoring

Form none

Baseline survey

Fillable Fileable

Form and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.