Final telephone screen

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

Documents and Forms

Document Name Document Type
0990-0308 Appendix B.doc Other-final telephone screen
0990-0308 Appendix C.doc Other-survey
0990-0308 Appendix A.doc 0990-0308 Appendix A IC Document

Information Collection (IC) Details

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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-final telephone screen			0990-0308 Appendix B.doc		No	No	Paper Only
Other-survey			0990-0308 Appendix C.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 167	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	167	-10	177
Annual IC Time Burden (Hours)	56	-3	59
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
0990-0308 Appendix A	0990-0308 Appendix A.doc	06/27/2013

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