BABI 6 - Month Questionnaire

Balance After Baby Intervention

Documents and Forms

Document Name Document Type
BABI 6 - Month Questionnaire Form and Instruction
6-month Quesionnaire for Control Group (English) Attachment 4-C_BABI_6MQuestionnaire_ENG_V1.0.pdf Form and Instruction
6-month Questionnaire for Intervention Group (English) Attachment 4-I_BABI_6MQuestionnaire_ENG_V1.0.pdf Form and Instruction
6-month Questionnaire for Control Group (Spanish) Attachment 4s-C_BABI_6MQuestionnaire_SPAN_V1.0.pdf Form and Instruction
6-month Questionnaire for Intervention Group (Spanish) Attachment 4s-I_BABI_6MQuestionnaire_SPAN_V1.0.pdf Form and Instruction

Information Collection (IC) Details

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

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	n/a	6-month Quesionnaire for Control Group (English)	Attachment 4-C_BABI_6MQuestionnaire_ENG_V1.0.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	6-month Questionnaire for Intervention Group (English)	Attachment 4-I_BABI_6MQuestionnaire_ENG_V1.0.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	6-month Questionnaire for Control Group (Spanish)	Attachment 4s-C_BABI_6MQuestionnaire_SPAN_V1.0.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	6-month Questionnaire for Intervention Group (Spanish)	Attachment 4s-I_BABI_6MQuestionnaire_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: 60	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	60	60
Annual IC Time Burden (Hours)	20	20
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.