Information Collection

Evidence-Based Falls Prevention Program (Project Staff)

IC 213600 under ICR 202103-0985-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Evidence-Based Falls Prevention Program (Project Staff)	Form and Instruction
Falls Semi-Annual Progress Report 0039 Falls-Semi-Annual-Progress-Report-and-Template-Instructions.pdf	Form and Instruction
Falls Semi-Annual Progress Report 0039 Falls-Semi-Annual-Progress-Report-and-Template-Instructions.pdf	Form and Instruction

IC Title:

Evidence-Based Falls Prevention Program (Project Staff)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	NA	Falls Semi-Annual Progress Report	0039 Falls-Semi-Annual-Progress-Report-and-Template-Instructions.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: 20

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	40	4	36
Annual IC Time Burden (Hours)	320	32	288
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.