Information Collection

NYPANS Student Questionnaire

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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2 National Youth Physical Activity and Nutrition Survey 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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	2				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 %

table that charts list of burden
	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

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

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

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