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:
201801-0985-002
Status:
Historical Active
Previous ICR Reference No:
201505-0985-013
Agency/Subagency:
HHS/ACL
Agency Tracking No:
Title:
Prevention and Public Health Funds Evidence-Based Falls Prevention Program Information Collection
Type of Information Collection:
Reinstatement with change of a previously approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved with change
Conclusion Date:
03/05/2018
Retrieve Notice of Action (NOA)
Date Received in OIRA:
02/02/2018
Terms of Clearance:
Approved with the understanding that the burden statement (including the OMB control number and expiration date) will appear on each of the instruments.
Inventory as of this Action
Requested
Previously Approved
Expiration Date
03/31/2021
36 Months From Approved
Responses
27,696
0
0
Time Burden (Hours)
4,344
0
0
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. 113 - 76 218
Name of Law: Prevention and Public Health Fund Reporting
PL:
Pub.L. 109 - 365 206
Name of Law: Evaluation
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:
82 FR 46064
10/03/2017
30-day Notice:
Federal Register Citation:
Citation Date:
83 FR 4659
02/01/2018
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, 3, 2, 5, 4
Falls Program Information Cover Sheet
,
Participant Information Form
,
Revised Post Session Survey
,
Attendance Log
,
Host Organization Information Form
Prevention and Public Health Funds Evidence-Based Falls Prevention Program (Staff Respondents)
5
Falls Semi-Annual Progress Report and Template Instructions
Prevention and Public Health Funds Evidenced-Based Falls Prevention Program (Individuals)
3, 2
Revised Participant Information
,
Revised 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
27,696
0
0
16,834
0
10,862
Annual Time Burden (Hours)
4,344
0
0
1,300
0
3,044
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
Yes
Burden Increase Due to:
Miscellaneous Actions
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
This collections has changes made to the collection instruments (forms/surveys) which were the result of comments received during the 60 day comment period.
Annual Cost to Federal Government:
$174,219
Does this IC contain surveys, censuses, or employ statistical methods?
No
Does this ICR request any personally identifiable information (see
OMB Circular No. A-130
for an explanation of this term)? Please consult with your agency's privacy program when making this determination.
No
Does this ICR include a form that requires a Privacy Act Statement (see
5 U.S.C. §552a(e)(3)
)? Please consult with your agency's privacy program when making this determination.
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:
Mark Snyderman 202 795-7439
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:
02/02/2018
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