Information Collection

NYPANS Student Questionnaire

IC 189798 under ICR 200907-0920-001 · OMB 0920-0832.

Documents and Forms

Document Name Document Type
Form 2 NYPANS Student Questionnaire Form and Instruction
2 National Youth Physical Activity and Nutrition Survey Appendix C- NYPANS Questionnaire.doc Form and Instruction
Appendix C1 - Questionnaire Administration Guide - NYPANS Only.doc Appendix C1 - Questionnaire Administration Guide - NYPANS Only IC Document
Appendix C2 - Questionnaire Administration Guide - NYPANS and 24-Hour Recall.doc Appendix C2 - Questionnaire Administration Guide - NYPANS and 24-Hour Recall IC Document
Appendix C3 - Parental Permission Form and Fact Sheet - NYPANS Only - English.doc Appendix C3 - Parental Permission Form and Fact Sheet - NYPANS Only - English IC Document
Appendix C4 - Parental Permission Form and Fact Sheet - NYPANS Only - Spanish.doc Appendix C4 - Parental Permission Form and Fact Sheet - NYPANS Only - Spanish IC Document
Appendix C5 - Parental Permission Form and Fact Sheet - NYPANS and 24-Hour Recall.doc Appendix C5 - Parental Permission Form and Fact Sheet - NYPANS and 24-Hour Recall IC Document
Appendix C6 - Parental Permission Form and Fact Sheet - NYPANS and 24-Hour Recall - Spanish.doc Appendix C6 - Parental Permission Form and Fact Sheet - NYPANS and 24-Hour Recall - Spanish IC Document
Appendix C7 - Parental Permission Form Reminder Notice - English.doc Appendix C7 - Parental Permission Form Reminder Notice - English IC Document
Appendix C8 - Parental Permission Form Reminnder Notice - Spanish.doc Appendix C8 - Parental Permission Form Reminnder Notice - Spanish IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	NYPANS Student Questionnaire	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	2	National Youth Physical Activity and Nutrition Survey	Appendix C- NYPANS Questionnaire.doc		No	No	Fillable Printable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 8,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	8,000	8,000
Annual IC Time Burden (Hours)	6,000	6,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Appendix C1 - Questionnaire Administration Guide - NYPANS Only	Appendix C1 - Questionnaire Administration Guide - NYPANS Only.doc	06/16/2009
Appendix C2 - Questionnaire Administration Guide - NYPANS and 24-Hour Recall	Appendix C2 - Questionnaire Administration Guide - NYPANS and 24-Hour Recall.doc	06/16/2009
Appendix C3 - Parental Permission Form and Fact Sheet - NYPANS Only - English	Appendix C3 - Parental Permission Form and Fact Sheet - NYPANS Only - English.doc	06/16/2009
Appendix C4 - Parental Permission Form and Fact Sheet - NYPANS Only - Spanish	Appendix C4 - Parental Permission Form and Fact Sheet - NYPANS Only - Spanish.doc	06/16/2009
Appendix C5 - Parental Permission Form and Fact Sheet - NYPANS and 24-Hour Recall	Appendix C5 - Parental Permission Form and Fact Sheet - NYPANS and 24-Hour Recall.doc	06/16/2009
Appendix C6 - Parental Permission Form and Fact Sheet - NYPANS and 24-Hour Recall - Spanish	Appendix C6 - Parental Permission Form and Fact Sheet - NYPANS and 24-Hour Recall - Spanish.doc	06/16/2009
Appendix C7 - Parental Permission Form Reminder Notice - English	Appendix C7 - Parental Permission Form Reminder Notice - English.doc	06/16/2009
Appendix C8 - Parental Permission Form Reminnder Notice - Spanish	Appendix C8 - Parental Permission Form Reminnder Notice - Spanish.doc	06/16/2009

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.