Information Collection

Follow-up Assessment of Matter of Balance Programs

IC 188658 under ICR 200904-0920-002 · OMB 0920-0818.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0818 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Follow-up Assessment of Matter of Balance Programs	Form
Follow-up Assessment of Matter of Balance Programs Attachment 2b - Follow-up assessment questionnaire.doc	Form

IC Title:

Follow-up Assessment of Matter of Balance Programs

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Follow-up Assessment of Matter of Balance Programs	Attachment 2b - Follow-up assessment questionnaire.doc		No	No	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 425

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	425	425
Annual IC Time Burden (Hours)	319	319
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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