BABI 12 - Month Questionnaire

Balance After Baby Intervention

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1115 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-15BEB BABI 12 - Month Questionnaire Form and Instruction
0920-15BEB Att 5_BABI_12MQuestionnaire_ENG_ Att 5_BABI_12MQuestionnaire_ENG_V1 0_01122016.pdf Form and Instruction
0920-15BEB Att 5s_BABI_12MQuestionnaire_SPAN Att 5s_BABI_12MQuestionnaire_SPAN_V1 0_01122016.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	BABI 12 - Month Questionnaire	Agency IC Tracking Number:	0920-15BEB

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-15BEB	Att 5_BABI_12MQuestionnaire_ENG_	Att 5_BABI_12MQuestionnaire_ENG_V1 0_01122016.pdf		No		Fillable Printable
Form and Instruction	0920-15BEB	Att 5s_BABI_12MQuestionnaire_SPAN	Att 5s_BABI_12MQuestionnaire_SPAN_V1 0_01122016.pdf		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 57	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	57	57
Annual IC Time Burden (Hours)	13	13
Annual IC Cost Burden (Dollars)	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.