Losing confidence in the ability to maintain balance can be more debilitating than a fall; therefore, the accurate measurement of balance confidence is critical. The purpose of this study was to examine the validity and reliability of the ABC-6, a shortened version of the Activities-specific Balance Confidence scale (ABC), among underserved older adults. The final sample included 251 older adults (M age = 71.2 years, SD = 8.9; 72.1% African Americans, 62.5% low-income, 61% low-education). Participants completed assessments of multiple falls risk factors, physical activity, and balance confidence. The ABC-6 had excellent internal consistency reliability, substantial intraclass correlations, and significant moderate to large correlations with physical activity, mobility, balance, and total falls risk. It also demonstrated the ability to discriminate between fallers and nonfallers, and it was a significant predictor of total falls risk. The ABC-6 was a valid and reliable measure of balance confidence among underserved older adults.