Baseline Survey Phone Mode

Test Predictability of Falls Screening Tools

OMB: 0920-1220

IC ID: 228499

Documents and Forms
Information Collection (IC) Details

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Baseline Survey Phone Mode 0920-17HO
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-17HO Att B-8 Baseline Survey_CATI_09 26 17 Att B-8 Baseline Survey_CATI_09 26 17.docx Yes Yes Fillable Printable

Health Public Health Monitoring

09-20-0136 Epidemiologic Studies and Surveillance of Disease Problems  57 FR 252

380 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 380 0 380 0 0 0
Annual IC Time Burden (Hours) 190 0 190 0 0 0
Annual IC Cost Burden (Dollars) 4,247 0 4,247 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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