Information Collection

Cost and Follow-up Assessment of Fall Prevention Programs

IC 188659 under ICR 201003-0920-004 · OMB 0920-0818.

Documents and Forms

Document Name Document Type
Cost and Follow-up Assessment of Fall Prevention Programs Form
Cost Assessment of AoA-funded Fall Prevention Programs Attachment_3_Cost_Template_(2-3-10)v8.xls Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Cost and Follow-up Assessment of Fall Prevention Programs	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Cost Assessment of AoA-funded Fall Prevention Programs	Attachment_3_Cost_Template_(2-3-10)v8.xls		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 66	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	66	-134	200
Annual IC Time Burden (Hours)	132	-268	400
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.