Participant Information Forms

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

OMB: 0985-0039

IC ID: 213597

Documents and Forms
Information Collection (IC) Details

View Information Collection (IC)

Participant Information Forms
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction NA Participant Information Form 0039 Participant-Information-Form.pdf Yes Yes Fillable Fileable
Form and Instruction NA Participant Post Session Survey 0039 Post Session Survey.pdf Yes Yes Fillable Fileable

Community and Social Services Social Services

 

19,624 0
   
Individuals or Households
 
   100 %

  Requested 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 19,624 0 2,896 0 0 16,728
Annual IC Time Burden (Hours) 1,961 0 287 0 0 1,674
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.

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