OMB control number

Older Adult Safe Mobility Assessment Tool

OMB 0920-1005 · HHS/CDC.

OMB 0920-1005

Latest Forms, Documents, and Supporting Material

Document Name
Follow-up Interview Guide Form and Instruction
Mobility Planning Tool (MPT) Form and Instruction
Baseline Interview Form and Instruction
Screener Interview Guide (Acceptance) Form and Instruction
Initial Screening (Refusal) Form and Instruction
OAMAT-ATO-08-29-2016.pdf Supplementary Document
Attach E PIA 2016.pdf Supplementary Document
Attach C3d NCIPC Research Determination Form_1005 OlderAdult.pdf Supplementary Document
Attach C3c_Analytic Plan and Illustrative Table Shells_1005 OlderAdult.doc Supplementary Document
Attach C3b_follow-up Letter.docx Supplementary Document
Attach C3a_Mobility Planning Tool.pdf Supplementary Document
Attach C2 IRB Protocol_1005 OlderAdult.pdf Supplementary Document
Attach C1_IRB approval letter 2016.pdf Supplementary Document
Attach B1_NonSubs Comment.pdf Supplementary Document
Attach B_60DyFRN2016.pdf Supplementary Document
Attach A_Authorizing Legislation_1005 OlderAdult.docx Supplementary Document
SSB_1005 OlderAdult_Exten ICRO_GB_9216.docx Supporting Statement B
SSA_1005 OlderAdult_Exten_ICRO_9716.docx Supporting Statement A
Follow-up Interview Guide Form and Instruction
Mobility Planning Tool (MPT) Form and Instruction
Baseline Interview Form and Instruction
Screener Interview Guide (Acceptance) Form and Instruction
Initial Screening (Refusal) Form and Instruction

All Historical Document Collections

201609-0920-002 Approved without change	Extension without change of a currently approved collection	2016-09-13
201511-0920-003 Approved without change	No material or nonsubstantive change to a currently approved collection	2015-11-12
201507-0920-013 Approved with change	Reinstatement with change of a previously approved collection	2015-08-05
201311-0920-013 Approved without change	New collection (Request for a new OMB Control Number)	2013-11-19