Baseline Interview

Older Adult Safe Mobility Assessment Tool

OMB: 0920-1005

IC ID: 217703

Documents and Forms
Information Collection (IC) Details

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Baseline Interview
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Interview Script Attachment D1 Screener and baseline interviewer guide_1005 OlderAdult ICRO Correct.docx Yes Yes Printable Only

Health Illness Prevention

09-20-0160 Records of Subjects in Health Promotion and Education Studies  51 FR 42484

1,000 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1,000 0 0 0 0 1,000
Annual IC Time Burden (Hours) 167 0 0 0 0 167
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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