In person interview-Field Test

The Effect of Reducing Falls on Acute and Long -Term Care Expenses

Documents and Forms

Document Name Document Type
0990ModelFallPreventionAppendix A.doc Other-Other
0990telephoneriskAppendix B.doc Other-Other
Appendix C-REDUCING FALLS.pdf Appendix C-REDUCING FALLS IC Document
0990HealthPromotionAppendix D.doc 0990HealthPromotionAppendix D IC Document

Information Collection (IC) Details

IC Title:	In person interview-Field Test	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

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
Other-Other			0990ModelFallPreventionAppendix A.doc		No	No	Paper Only
Other-Other			0990telephoneriskAppendix B.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 177	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-177	177
Annual IC Time Burden (Hours)	-236	236
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Appendix C-REDUCING FALLS	Appendix C-REDUCING FALLS.pdf	11/09/2006
0990HealthPromotionAppendix D	0990HealthPromotionAppendix D.doc	11/09/2006

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.