Initial Telephone Screen

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0308 can be found here:

Documents and Forms

Document Name Document Type
0990ModelFallPreventionAppendix A.doc Other-Other

Information Collection (IC) Details

IC Title:	Initial Telephone Screen	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 241.301

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

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 240	Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	240	-960	1,200
Annual IC Time Burden (Hours)	80	-320	400
Annual IC Cost Burden (Dollars)	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.