Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Client Process Evaluation Interview New 169 85 0 Other-Client Process Evaluation Interview
Other-Appendix I. Client Process Evaluation Interview
Home Hazard Checklist (Baseline) New 3000 1260 0 Other-Home Hazard Checklist (Baseline)
Other-Home Hazard Checklist (Baseline)
Home Hazard Checklist (Post-modification) New 1688 709 0 Other-Home Hazard Checklist (Post-modification)
Other-Home Hazard Checklist (Post-modification)
OAHM Client Impact Evaluation Interview (Baseline) New 2250 743 0 Other-OAHM Client Impact Evaluation Interview (Baseline)
Other-OAHM Client Impact Evaluation Interview (Baseline)
OAHM Client Impact Evaluation Interview (Post-modification) New 1688 557 0 Other-OAHM Client Impact Evaluation Interview (Post-modification)
Other-OAHM Client Impact Evaluation Interview (Post-modification)
OAHM Client Program Questionnaire (Baseline) New 3000 300 0 Other-OAHM Client Program Questionnaire (Baseline)
Other-OAHM Client Program Questionnaire (Baseline)
OAHM Client Program Questionnaire (Post-modification) New 1688 169 0 Other-OAHM Client Program Questionnaire (Post-modification)
Other-OAHM Client Program Questionnaire (Post-modification)
OAHM Program Evaluation Informed Consent New 2250 563 0 Other-OAHM Program Evaluation Informed Consent
Other-OAHM Program Evaluation Informed Consent
Script to Schedule Client Process Evaluation Interview New 188 15 0 Other-Script to Schedule Client Process Evaluation Interview
Other-Script to Schedule Client Process Evaluation Interview
Total burden requested under this ICR: 15921 4401 0  
To view an IC, click on IC Title