View Information Collection Request (ICR) Package
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Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
0985-0039
ICR Reference No:
201505-0985-013
Status:
Historical Active
Previous ICR Reference No:
201410-0985-001
Agency/Subagency:
HHS/ACL
Agency Tracking No:
Title:
Prevention and Public Health Funds Evidence-Based Falls Prevention Program Information Collection
Type of Information Collection:
No material or nonsubstantive change to a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
05/29/2015
Retrieve Notice of Action (NOA)
Date Received in OIRA:
05/28/2015
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
01/31/2018
01/31/2018
01/31/2018
Responses
10,862
0
10,862
Time Burden (Hours)
3,044
0
3,044
Cost Burden (Dollars)
0
0
0
Abstract:
The Administration on Aging (AoA), Administration for Community Living (ACL), is proposing to use this set of data collection tools to monitor 10 cooperative agreements to states and 4 cooperative agreements to tribal entities that will be awarded in response to the "PPHF-2014-Evidence-Based Falls Prevention Programs financed solely by 2014 Prevention and Public Health Funds (PPHF-2014)" funding opportunity announcement (FOA). The PPHF is accompanied by a high level of transparency, oversight, and accountability. All recipients of PPHF must follow Health and Human Services guidance related to the tracking, monitoring and reporting on the use of PPHF financing. ACL/AoA outlined basic reporting requirements in the Evidence-Based Falls Prevention FOA and will also list these requirements in the Standard Terms and Conditions of grantees' notice of awards. These Terms and Conditions will require each grantee to prepare and submit progress reports to ACL/AoA that will enable the agency to monitor program performance. ACL/AoA will use the information to: 1) Comply with reporting requirements required by the authorizing statues, 2) Collect data for performance measures used in the justification of the budget to Congress and by program, state and national decision makers, 3) Effectively manage the PPHF Falls Prevention program at the federal, state, and local levels, 4) Identify program implementation issues and pinpoint areas for technical assistance activities, 5) Identify best practices in program implementation and building sustainable program delivery systems and to develop resources to enable current and future grantees to learn from and replicate these practices; and 6) Provide information as requested for reports to Congress, other governmental agencies, stakeholders and to the public upon request about PPHF Falls Prevention grantee progress. Data will be collected from project level staff, local community agency staff involved in delivering the evidence-based falls prevention programs, as well as individuals who participate in the falls prevention programs.
Authorizing Statute(s):
PL:
Pub.L. 109 - 365 206
Name of Law: Evaluation
PL:
Pub.L. 113 - 76 218
Name of Law: Prevention and Public Health Fund Reporting
PL:
Pub.L. 109 - 365 411
Name of Law: Program Authorization
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
79 FR 36527
06/27/2014
30-day Notice:
Federal Register Citation:
Citation Date:
79 FR 180
09/17/2014
Did the Agency receive public comments on this ICR?
Yes
Number of Information Collection (IC) in this ICR:
3
IC Title
Form No.
Form Name
Prevention and Public Health Funds Evidence-Based Falls Prevention Program (Local Respondents)
1, 2, 4, 3, 6
Falls Program Information Sheet
,
Participant Information
,
Post Session Survey
,
Attendance Log
,
Host Organization
Prevention and Public Health Funds Evidence-Based Falls Prevention Program (Staff Respondents)
5
Falls Performance Report
Prevention and Public Health Funds Evidenced-Based Falls Prevention Program (Individuals)
2, 3
Participant Information
,
Post Session Survey
ICR Summary of Burden
Total Approved
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in Estimate
Change Due to Potential Violation of the PRA
Annual Number of Responses
10,862
10,862
0
0
0
0
Annual Time Burden (Hours)
3,044
3,044
0
0
0
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
No
Burden Increase Due to:
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
This is a new collection that ACL wishes to implement.
Annual Cost to Federal Government:
$116,098
Does this IC contain surveys, censuses, or employ statistical methods?
No
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
No
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
Yes
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
No
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
Jason Bennett 202 357-3408 Jason.Bennett@aoa.hhs.gov
Common Form ICR:
No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date:
05/28/2015
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