Screener Interview Guide (Acceptance)

Older Adult Safe Mobility Assessment Tool

OMB: 0920-1005

IC ID: 217702

Documents and Forms
Information Collection (IC) Details

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Screener Interview Guide (Acceptance)
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction none Baseline Interview Guide Attach D1 Screener Interviewer guide_1005 OlderAdult_Ext_ICRO_9216.docx Yes Yes Fillable Fileable

Health Public Health Monitoring

09-20-0160 Records of Subjects in Health Promotion and Education Studies  51 FR 42484

750 0
   
Individuals or Households
 
   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 750 0 -750 0 0 1,500
Annual IC Time Burden (Hours) 63 0 -62 0 0 125
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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