Follow-up Interview Guide

Older Adult Safe Mobility Assessment Tool

OMB: 0920-1005

IC ID: 217705

Documents and Forms
Information Collection (IC) Details

View Information Collection (IC)

Follow-up Interview Guide
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction none Follow-up Interview Guide Attach D2 Follow Up Interviewer Guide_1005 OlderAdult_Ext.docx Yes Yes Fillable Fileable

Health Illness Prevention

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

450 0
   
Individuals or Households
 
   100 %

  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 450 0 -450 0 0 900
Annual IC Time Burden (Hours) 75 0 -75 0 0 150
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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