Older Adult Mobility Ride Share (OAMRS)

CDC/ATSDR Formative Research and Tool Development

OMB: 0920-1154

IC ID: 231946

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Older Adult Mobility Ride Share (OAMRS) 0920-1154-18AEF
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-1154 Written Questionnaire Focus Group Attachment B - Written Questionnaire Focus Group_Revised20180618.docx NA No   Fillable Fileable
Form and Instruction 0920-1154 Focus Group Protocol - Users Attachment C - Focus Group Protocol - Users.doc na No   Fillable Fileable
Form and Instruction 0920-1154 Focus Group Protocol - Non-Users Attachment D - Focus Group Protocol - Non-Users.doc NA No   Fillable Fileable
Form and Instruction 0920-1154 Interview Protocol - Users Attachment E - Interview Protocol - Users_Revised20180618.docx NA No   Fillable Fileable
Form and Instruction 0920-1154 Interview Protocol - Non-Users Attachment F - Interview Protocol - Non-Users_Revised20180618.docx NA No   Fillable Fileable
Form and Instruction 0920-1154 Screener Focus Group Attachment J - Screener Focus Group.docx NA No   Fillable Fileable
Form and Instruction 0920-1154 Screener Telephone Interview Attachment K - Screener Telephone Interview.docx NA No   Fillable Fileable

Health Public Health Monitoring

 

535 0
   
Individuals or Households
 
   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 535 0 535 0 0 0
Annual IC Time Burden (Hours) 190 0 190 0 0 0
Annual IC Cost Burden (Dollars) 9,786 0 9,786 0 0 0

Title Document Date Uploaded
Ride Share Partner Outreach Materials Attachment A - Ride Share Partner Outreach Materials.docx 06/26/2018
Informed Consent Attachment G - Informed Consent - Focus Group Protocol Users_Non.doc 06/26/2018
Flyer for Recruitment Attachment H - Flyer for Recruitment.docx 06/26/2018
Study Description Attachment I - Study Description.docx 06/26/2018
Communication Materials Attachment L - Communication Materials.docx 06/26/2018
PIA Attachment M - PIA.PDF 06/26/2018
IRB Documentation Attachment N - IRB Documentation.pdf 06/26/2018
GenIC Request Template OAMRS GenIC Request Template_Older Adult Mobility Ride Share (OAMRS)_5_1_18_aj.docx 06/26/2018
SSA OAMRS SSA_GenIC_1154_Older Adult Mobility Ride Share_Revised20180618.docx 06/26/2018
SSB OAMRS SSB_GenIC_1154_Older Adult Mobility Ride Share_5_1_18.docx 06/26/2018
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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