Information Collection

Final telephone screen

IC 46272 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

IC Title:

Final telephone screen

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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
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 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	177	57	120
Annual IC Time Burden (Hours)	59	39	20
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.