GenIC "Primary Care Provider - Stopping Elderly Accidents, Deaths, and Injuries (STEADI)"

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1009 can be found here:

Documents and Forms

Document Name Document Type
Att A_Recruiting Scripts.docx Other-WORD
Att B_Focus Group Moderator Guide.docx Other-WORD
Att C_Phone Interview Script.docx Other-WORD
Att D_Steadi Flyer-Primary Care.pdf Steadi Flyer_Primary Care IC Document
GenIC_Request_STEADI_102616.docx Request for Approval IC Document

Information Collection (IC) Details

IC Title:	GenIC "Primary Care Provider - Stopping Elderly Accidents, Deaths, and Injuries (STEADI)"	Agency IC Tracking Number:	17BY

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Electronic Capability
Other-WORD	Att A_Recruiting Scripts.docx	No	Fillable Fileable
Other-WORD	Att B_Focus Group Moderator Guide.docx	No	Fillable Fileable
Other-WORD	Att C_Phone Interview Script.docx	No	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 182	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	182	182
Annual IC Time Burden (Hours)	73	73
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Steadi Flyer_Primary Care	Att D_Steadi Flyer-Primary Care.pdf	10/26/2016
Request for Approval	GenIC_Request_STEADI_102616.docx	10/27/2016

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.