Information Collection

Prevention and Public Health Funds Evidenced-Based Falls Prevention Program (Individuals)

IC 213597 under ICR 201502-0985-001 · OMB 0985-0039.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0985-0039 can be found here:

Documents and Forms

Document Name Document Type
Form 2 Prevention and Public Health Funds Evidenced-Based Falls Prevention Program (Individuals) Form and Instruction
2 Participant Information Attachment_2_Participant_Information_Form.pdf Form and Instruction
3 Post Session Survey Attachment_3_Post_Session_Survey.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Prevention and Public Health Funds Evidenced-Based Falls Prevention Program (Individuals)	Agency IC Tracking Number:

Is this a Common Form? Yes		IC Status: Unchanged

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
Form and Instruction	2	Participant Information	Attachment_2_Participant_Information_Form.pdf		Yes	Yes	Fillable Fileable
Form	3	Post Session Survey	Attachment_3_Post_Session_Survey.pdf		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	10,000	10,000
Annual IC Time Burden (Hours)	2,000	2,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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