OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

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

OMB 0920-1281 · HHS/CDC.

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 is listed under ICR 202007-0920-011.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form 0920-19ARD Operations Manager InterivewForm and Instruction
Provider Interview GuideForm and Instruction
Form 0920-19ARD Consent FormForm and Instruction
Follow-up SurveyForm and Instruction
Baseline SurveyForm 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.docxSupporting Statement B
SSA STEADI eval primary care_ 10_9_19 final.docxSupporting 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

Historical document collections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

OMB Details

Baseline Survey

Federal Enterprise Architecture: Health - Public Health Monitoring

Information collection instruments
FormNameElectronic accessType
Form noneBaseline surveyFillable FileableForm and instruction

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