Information Collection

Intial telephone screen

IC 46270 under ICR 201306-0990-003 · OMB 0990-0308.

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:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

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					No	No	Paper Only
Other-Other					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 %

table that charts list of burden
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-240	240
Annual IC Time Burden (Hours)	-80	80
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Appendix C-REDUCING FALLS		11/09/2006
0990HealthPromotionAppendix D		11/09/2006

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

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