Information Collection

Jump Start phone call

IC 46266 under ICR 201004-0990-002 · OMB 0990-0308.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0308 can be found here:

Documents and Forms

Document Name Document Type
0990ModelFallPreventionAppendix A.doc Other-Other
0990telephoneriskAppendix B.doc Other-Other
Appendix C-REDUCING FALLS.pdf Appendix C-REDUCING FALLS IC Document
0990HealthPromotionAppendix D.doc 0990HealthPromotionAppendix D IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Jump Start phone call	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Other			0990ModelFallPreventionAppendix A.doc		No	No	Paper Only
Other-Other			0990telephoneriskAppendix B.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 240	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	240	-960	1,200
Annual IC Time Burden (Hours)	120	-480	600
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Appendix C-REDUCING FALLS	Appendix C-REDUCING FALLS.pdf	11/09/2006
0990HealthPromotionAppendix D	0990HealthPromotionAppendix D.doc	11/09/2006

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