Information Collection

Bodyworks program particpants-English and Spanish Follow ups

IC 198439 under ICR 201107-0990-002 · OMB 0990-0385.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0990-BodyWorks_Full Evaluation_child follow-up_ENG.docx	Other-evaluation
0990-BodyWorks_Full Evaluation_child follow-up_SPAN.docx	Other-survey
0990-BodyWorks_Full Evaluation_parent followup_SPAN.doc	Other-survey
0990-BodyWorks_Full Evaluation_parent follow-up_ENG.docx	Other-survey

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-evaluation	0990-BodyWorks_Full Evaluation_child follow-up_ENG.docx	Yes	Yes	Fillable Printable
Other-survey	0990-BodyWorks_Full Evaluation_child follow-up_SPAN.docx	Yes	Yes	Printable Only
Other-survey	0990-BodyWorks_Full Evaluation_parent followup_SPAN.doc	Yes	Yes	Fillable Printable
Other-survey	0990-BodyWorks_Full Evaluation_parent follow-up_ENG.docx	Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 256

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	256	256
Annual IC Time Burden (Hours)	85	85
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.