Information Collection

BABI 6 - Week Questionnaire

IC 219641 under ICR 201805-0920-009 · OMB 0920-1115.

Documents and Forms

Documents and forms in this information collection
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

IC Title:

Agency IC Tracking Number:

15BEB

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

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

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 %

table that charts list of burden
	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

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.