Information Collection

Alabama Safe Sleep Outreach Project

IC 220000 under ICR 201403-0925-009 · OMB 0925-0701.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0701 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Alabama Safe Sleep Outreach Project	Form and Instruction
1 Substudy AlabamaOutreach PaperworkChecklist 0925-0701_Substudy_AlabamaOutreach_ PaperworkChecklist.docx	Form and Instruction
2 Substudy AlabamaOutreach PrePostAssessment 0925-0701_Substudy_AlabamaOutreach_ PrePostAssessment.docx	Form and Instruction
3 Substudy AlabamaOutreach Activity/Tracking 0925-0701_Substudy_AlabamaOutreach_ActivityTracking.docx	Form and Instruction
4 Substudy AlabamaOutreach Signin 0925-0701_Substudy_AlabamaOutreach_SignIn.docx	Form and Instruction
0925-0701_Substudy_AlabamaOutreach_ MiniSSA.docx Substudy_AlabamaOutreach Mini SSA	IC Document
0925-0701_Substudy_AlabamaOutreach_ MiniSSB.docx Substudy_AlabamaOutreach Mini SSB	IC Document

IC Title:

Alabama Safe Sleep Outreach Project

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form and Instruction	1	Substudy AlabamaOutreach PaperworkChecklist	0925-0701_Substudy_AlabamaOutreach_ PaperworkChecklist.docx	No	Paper Only
Form and Instruction	2	Substudy AlabamaOutreach PrePostAssessment	0925-0701_Substudy_AlabamaOutreach_ PrePostAssessment.docx	No	Paper Only
Form and Instruction	3	Substudy AlabamaOutreach Activity/Tracking	0925-0701_Substudy_AlabamaOutreach_ActivityTracking.docx	No	Paper Only
Form and Instruction	4	Substudy AlabamaOutreach Signin	0925-0701_Substudy_AlabamaOutreach_SignIn.docx	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,630

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	2,630	2,630
Annual IC Time Burden (Hours)	189	189
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Substudy_AlabamaOutreach Mini SSA	0925-0701_Substudy_AlabamaOutreach_ MiniSSA.docx	02/05/2016
Substudy_AlabamaOutreach Mini SSB	0925-0701_Substudy_AlabamaOutreach_ MiniSSB.docx	02/05/2016

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.