Information Collection

Automatic Self-Administered 24-hour Dietary Recall (ASA24)

IC 186341 under ICR 200808-0925-004 · OMB 0925-0594.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0594 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 4-1B Automatic Self-Administered 24-hour Dietary Recall (ASA24)	Form
Att 4-1A_ASA24BurdenPage.pdf 72.51.43.13/asa24/	Instruction
4-1B ASA24 instrument Att 4-1B_ Instrument ASA24.pdf asa24test.westat.com	Form

IC Title:

Automatic Self-Administered 24-hour Dietary Recall (ASA24)

Agency IC Tracking Number:

Is this a Common Form? Yes

IC Status: New

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	4-1B	ASA24 instrument	Att 4-1B_ Instrument ASA24.pdf	http://asa24test.westat.com	Yes	Yes	Fillable Fileable
Instruction			Att 4-1A_ASA24BurdenPage.pdf	http://72.51.43.13/asa24/	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,036

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,760	1,760
Annual IC Time Burden (Hours)	880	880
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.