Home Hazard Checklist (Baseline)

Evaluation of the Older Adults Home Modification Grant Program

OMB: 2528-0335

IC ID: 250819

Documents and Forms
Document Name
Document Type
Other-Home Hazard Checklist (Baselin
Other-Home Hazard Checklist (Baselin
Other-Home Hazard Checklist (Baselin
Other-Home Hazard Checklist (Baselin
Other-Appendix D. Home Hazard Checkl
Other-Appendix D. Home Hazard Checkl
Information Collection (IC) Details

View Information Collection (IC)

Home Hazard Checklist (Baseline)
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Home Hazard Checklist (Baseline) Appendix D. Home Hazard Checklist Form_OAHM_Final.docx No   Paper Only
Other-Home Hazard Checklist (Baseline) Appendix D. Home Hazard Checklist Form_OAHM_FINAL_SPL.docx No   Paper Only
Other-Appendix D. Home Hazard Checklist_EOAHMP-C2.DRAFT(clean) Appendix D. Home Hazard Checklist_EOAHMP-C2.DRAFT(clean).docx No   Paper Only

Community and Social Services Community and Regional Development

 

3,000 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 3,000 0 0 0 0 3,000
Annual IC Time Burden (Hours) 1,260 0 0 0 0 1,260
Annual IC Cost Burden (Dollars) 0 0 0 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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