OMB
.report
Search
BABI 24 - Month Questionnaire
Balance After Baby Intervention
OMB: 0920-1115
IC ID: 219654
OMB.report
HHS/CDC
OMB 0920-1115
ICR 201805-0920-009
IC 219654
( )
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
Federal Enterprise Architecture Business Reference Module
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
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
51
0
0
0
0
51
Annual IC Time Burden (Hours)
13
0
0
0
0
13
Annual IC Cost Burden (Dollars)
0
0
0
0
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.