Information Collection Request

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

ICR 202103-0985-001 · OMB 0985-0039 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Falls Semi-Annual Progress Report Form and Instruction Modified Available
Evidence-Based Falls Prevention Program (Project Staff) Form and Instruction Modified Repair queued
Host Information Form Form and Instruction Modified Repair queued
Attendance Log Form and Instruction Modified Available
Post Session Survey Form and Instruction Modified Available
Participant Information Form Form and Instruction Modified Repair queued
Cover Sheet Form and Instruction Modified Available
Evidence-Based Falls Prevention Program (Local Respondents) Form and Instruction Modified Repair queued
Post Session Survey Form and Instruction Modified Repair queued
Participant Form Form and Instruction Modified Available
Participant Information Forms Form and Instruction Modified Repair queued
0039 Public comment summary.pdf Supplementary Document Uploaded 2021-03-11 Repair queued
0039 Falls Prevention Supporting Statement - 2021 Final.pdf Supporting Statement A Uploaded 2021-03-11 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
213600 Evidence-Based Falls Prevention Program (Project Staff) Form and Instruction ModifiedFalls Semi-Annual Progress Report
213600 Evidence-Based Falls Prevention Program (Project Staff) Form and Instruction Modified
213599 Evidence-Based Falls Prevention Program (Local Respondents) Form and Instruction ModifiedHost Information Form
213599 Evidence-Based Falls Prevention Program (Local Respondents) Form and Instruction ModifiedAttendance Log
213599 Evidence-Based Falls Prevention Program (Local Respondents) Form and Instruction ModifiedPost Session Survey
213599 Evidence-Based Falls Prevention Program (Local Respondents) Form and Instruction ModifiedParticipant Information Form
213599 Evidence-Based Falls Prevention Program (Local Respondents) Form and Instruction ModifiedCover Sheet
213599 Evidence-Based Falls Prevention Program (Local Respondents) Form and Instruction Modified
213597 Participant Information Forms Form and Instruction ModifiedPost Session Survey
213597 Participant Information Forms Form and Instruction ModifiedParticipant Form
213597 Participant Information Forms Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
04/30/2024 36 Months From Approved 04/30/2021
17,680 0 27,696
2,888 0 4,344
0 0 0





Reginfo record details
3
table that charts list of burden
IC Title Form No. Form Name
Evidence-Based Falls Prevention Program (Local Respondents) NA, NA, NA, NA, NA ,   ,   ,   ,  
Evidence-Based Falls Prevention Program (Project Staff) NA
Participant Information Forms NA, NA ,  

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 17,680 27,696 0 -10,016 0 0
Annual Time Burden (Hours) 2,888 4,344 0 -1,456 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No