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Survey for Older Adults - Participants
Examining how Local Health Departments Leverage Age-Friendly Cities Initiatives to Build Resilience in Elderly Populations
OMB: 0920-1093
IC ID: 217679
OMB.report
HHS/CDC
OMB 0920-1093
ICR 201507-0920-015
IC 217679
( )
Documents and Forms
Document Name
Document Type
Survey for Older Adults - Participants
Form and Instruction
Senior Village Survey
Attachment_C_Survey_for_Older_Adults.docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Survey for Older Adults - Participants
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
New
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 and Instruction
none
Senior Village Survey
Attachment_C_Survey_for_Older_Adults.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Disaster Management
Subfunction:
Disaster Preparedness and Planning
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
775
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
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
775
0
775
0
0
0
Annual IC Time Burden (Hours)
258
0
258
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
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.