Information Collection Request

Prevention and Public Health Funds Evidence-Based Falls Prevention Program Information Collection

ICR 201502-0985-001 · OMB 0985-0039 · Historical Inactive

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 5 Falls Performance Report Form and Instruction Unchanged Available
Form 6 Host Organization Form Unchanged Repair queued
Form 4 Attendance Log Form Unchanged Available
Form 3 Post Session Survey Form Unchanged Available
Form 2 Participant Information Form Unchanged Available
Form 1 Falls Program Information Sheet Form and Instruction Unchanged Available
Form 3 Post Session Survey Form Unchanged Available
Form 2 Participant Information Form and Instruction Unchanged Available
Falls Data Collection ACL Response to OMB Comments 3-17-15.docx Supplementary Document Uploaded 2015-05-22 Available
OMB Falls_Prevention_Non substantive change request 1-28-15.docx Justification for No Material/Nonsubstantive Change Uploaded 2015-02-06 Available
Falls_Prevention_PartB_revised 4-17-15.docx Supporting Statement B Uploaded 2015-05-22 Available
Falls Supporting_Statement 1-23-15.docx Supporting Statement A Uploaded 2015-01-26 Available

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
01/31/2018 01/31/2018 01/31/2018
10,862 0 10,862
3,044 0 3,044
0 0 0





Reginfo record details
3
table that charts list of burden
IC Title Form No. Form Name
Prevention and Public Health Funds Evidence-Based Falls Prevention Program (Local Respondents) 1, 2, 4, 3, 6 ,   ,   ,   ,  
Prevention and Public Health Funds Evidence-Based Falls Prevention Program (Staff Respondents) 5
Prevention and Public Health Funds Evidenced-Based Falls Prevention Program (Individuals) 2, 3 ,  



Reginfo record details
  Yes
 
Reginfo record details
table that charts list of RCF
Agency/Sub Agency RCF ID RCF Title RCF Status IC Title