Information Collection

Cost and Follow-up Assessment of Fall Prevention Programs

IC 188659 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⚠️ Notice: This information collection may be referencing outdated material.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
Cost and Follow-up Assessment of Fall Prevention Programs	Form
Cost Assessment of Fall Prevention Programs Attachment 3 Cost Template (1-16-09)v8.xls	Form

IC Title:

Cost and Follow-up Assessment of Fall Prevention 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	Cost Assessment of Fall Prevention Programs	Attachment 3 Cost Template (1-16-09)v8.xls		No	No	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200

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	200	200
Annual IC Time Burden (Hours)	400	400
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.