Information Collection

BABI 24 - Month Questionnaire

IC 219654 under ICR 201805-0920-009 · OMB 0920-1115.

Documents and Forms

Document Name Document Type
BABI 24 - Month Questionnaire Form and Instruction
End of Study questionnaire - English Attachment 7_BABI_24MQuestionnaire_ENG_V1.0.pdf Form and Instruction
End of Study questionnaire - Spanish Attachment 7s_BABI_24MQuestionnaire_SPAN_V1.0.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	BABI 24 - Month Questionnaire	Agency IC Tracking Number:	0920-15BEB

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	none	End of Study questionnaire - English	Attachment 7_BABI_24MQuestionnaire_ENG_V1.0.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	none	End of Study questionnaire - Spanish	Attachment 7s_BABI_24MQuestionnaire_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: 51	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	51	51
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.