BABI 6 - Week 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⚠️ Notice: This information collection may be referencing outdated material.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
BABI 6 - Week Questionnaire Form and Instruction
6-week Questionnaire (English) Attachment 3_BABI_6WQuestionnaire_ENG_V1.0.pdf Form and Instruction
6-week Questionnaire (Spanish) Attachment 3s_BABI_6WQuestionnaire_SPAN_V1.0.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	BABI 6 - Week Questionnaire	Agency IC Tracking Number:	15BEB

Is this a Common Form? No		IC Status: Modified

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	n/a	6-week Questionnaire (English)	Attachment 3_BABI_6WQuestionnaire_ENG_V1.0.pdf		Yes	Yes	Fillable Printable
Form and Instruction	n/a	6-week Questionnaire (Spanish)	Attachment 3s_BABI_6WQuestionnaire_SPAN_V1.0.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 63	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	63	63
Annual IC Time Burden (Hours)	18	18
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.