Stopping Elderly Accidents, Deaths, and Injuries (STEADI) in a Hospital Discharge Setting

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

Documents and Forms

Document Name Document Type
Attachment C –Falls Prevention Participant Survey.docx Other-WORD
Attachment B_Invitation Correspondence.docx Other-WORD
Att. A Privacy Act.pdf Att A_D Intellix Award email (Privacy Determination) IC Document
GenIC_Request_STEADI Hospital Discharge Setting.docx Request for Approval (0920-1005) IC Document

Information Collection (IC) Details

IC Title:	Stopping Elderly Accidents, Deaths, and Injuries (STEADI) in a Hospital Discharge Setting	Agency IC Tracking Number:	0920-1009 (18KW)

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
Other-WORD			Attachment C –Falls Prevention Participant Survey.docx		Yes	Yes	Paper Only
Other-WORD			Attachment B_Invitation Correspondence.docx		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,532	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,532	1,532
Annual IC Time Burden (Hours)	104	104
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Att A_D Intellix Award email (Privacy Determination)	Att. A Privacy Act.pdf	02/20/2018
Request for Approval (0920-1005)	GenIC_Request_STEADI Hospital Discharge Setting.docx	02/20/2018

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