OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Evaluating the implementation and impact of an opioid medication management program, in a hospital discharge setting, to reduce falls in older adults

OMB 0920-1285 ยท HHS/CDC.

OMB 0920-1285

The goal of this data collection is to conduct a formative evaluation to inform CDC of best practices for implementation of a fall prevention program into the hospital discharge process targeting opioid prescribing and management.

The latest form for Evaluating the implementation and impact of an opioid medication management program, in a hospital discharge setting, to reduce falls in older adults expires 2023-02-28 and is listed under ICR 201910-0920-007.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
PCP post-discharge surveyForm
Clinical staff questionnaireForm
Post-discharge Patient QuestionnaireForm
Pre-discharge patient questionnaireForm
POMI-test-article.pdf Supplementary Document
SAMHSA email.pdf Supplementary Document
NCHS email.pdf Supplementary Document
Crosswalk Post Patient Survey Questions.docx Supplementary Document
Crosswalk Pre Patient Survey Questions.docx Supplementary Document
Attachment H Patient Consent Form .docx Supplementary Document
Attachment G3 Correspondence to primary care providers.docx Supplementary Document
Attachment G2 Correspondence to UCSF clinical staff.docx Supplementary Document
Attachment G1 Correspondence to patients.docx Supplementary Document
Attachment F1. Illustrative table shells.xlsx Supplementary Document
Attachment D IRB_Approval letter.pdf Supplementary Document
Attachment C PIA.pdf Supplementary Document
Attachment B 60 day FRN.pdf Supplementary Document
Attachment A Authorizing Legislation.docx Supplementary Document
SSB_Evaluating implementation fall prevention program 10.9.19.docxSupporting Statement B
SSA_Evaluating implementation fall prevention program_10.21.19.docxSupporting Statement A
PCP post-discharge survey Form
Clinical staff questionnaire Form
Post-discharge Patient Questionnaire Form
Pre-discharge patient questionnaire Form

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
201910-0920-007 New collection (Request for a new OMB Control Number) 2019-11-21 Approved with change

OMB Details

Pre-discharge patient questionnaire

Federal Enterprise Architecture: Health - Illness Prevention

Information collection instruments
FormNameElectronic accessType
Form nonePre-discharge questionnaireFillable FileableForm

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