Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Prevention and Public Health Funds Evidence-Based Falls Prevention Program (Local Respondents) Modified 1436 1434 0 Form and Instruction 1 Falls Program Information Cover Sheet
Form 2 Participant Information Form
Form 3 Revised Post Session Survey
Form 4 Attendance Log
Form 5 Host Organization Information Form
Prevention and Public Health Funds Evidence-Based Falls Prevention Program (Staff Respondents) Modified 36 288 0 Form and Instruction 5 Falls Semi-Annual Progress Report and Template Instructions
Prevention and Public Health Funds Evidenced-Based Falls Prevention Program (Individuals) Modified 26224 2622 0 Form and Instruction 2 Revised Participant Information
Form 3 Revised Post Session Survey
Total burden requested under this ICR: 27696 4344 0  
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