Evidence-Based Falls Prevention Program (Project Staff)

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0985-0039 can be found here:

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.