Form 3 National Youth Physical Activityand Nutrition Survey Hei

D. Height and Weight Record Form

Form Approved:

OMB No.: 0920XXXX

Expiration Date: XX/XXX/XXXX

National Youth Physical Activity and Nutrition Survey

Height and Weight Record Form

Height					Weight
Feet	Inches
3	0				0	0	0
4	1				1	1	1
5	2				2	2	2
6	3				3	3	3
7	4					4	4
	5					5	5
	6					6	6
	7					7	7
	8					8	8
	9					9	9
	10
	11

Refused Refused

Measurement Problems Measurement Problems

Public reporting burden for this collection of information is estimated to average 3 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: CDC Reports Clearance Officer, 1600 Clifton Road, MS D-74, Atlanta, GA 30333, ATTN:PRA (0920-XXXX)