In person interview-Field Test

The Effect of Reducing Falls on Acute and Long -Term Care Expenses

⚠️ Notice: This information collection may be referencing outdated material.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

IC Title:	In person interview-Field Test	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: 177	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	177	117	60
Annual IC Time Burden (Hours)	236	176	60
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.