OMB
.report
Search
Older Adult Mobility Planning Brochure
CDC and ATSDR Health Message Testing System
OMB: 0920-0572
IC ID: 229714
OMB.report
HHS/CDC
OMB 0920-0572
ICR 201502-0920-001
IC 229714
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0572 can be found here:
2024-10-18 - Revision of a currently approved collection
2021-08-31 - Extension without change of a currently approved collection
Documents and Forms
Document Name
Document Type
Att E_Confirmatory Letter.pdf
Instruction
Att F_Focus Group M Guide.docx
Other-Focus Group Guide
Participant Screener
Att C_Participant Screener_v2.docx
Form and Instruction
HMTSExpeditedReviewForm Mobility Planning Tool.pdf
HMTS Expedited Review Form
IC Document
Att A_My Mobility brochure.pdf
My Mobility Brochure
IC Document
Att. B. Project Description.docx
Project Description
IC Document
Att D_Consent Form_rev.docx
Consent
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Older Adult Mobility Planning Brochure
Agency IC Tracking Number:
0920-0572-18GR
IC Status:
New
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Instruction
Att E_Confirmatory Letter.pdf
Yes
No
Paper Only
Other-Focus Group Guide
Att F_Focus Group M Guide.docx
Yes
No
Paper Only
Form and Instruction
none
Participant Screener
Att C_Participant Screener_v2.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Consumer Health and Safety
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
36
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
36
0
36
0
0
0
Annual IC Time Burden (Hours)
106
0
106
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
HMTS Expedited Review Form
HMTSExpeditedReviewForm Mobility Planning Tool.pdf
01/11/2018
My Mobility Brochure
Att A_My Mobility brochure.pdf
01/11/2018
Project Description
Att. B. Project Description.docx
01/11/2018
Consent
Att D_Consent Form_rev.docx
01/11/2018
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.