Student Contact Information for Dietary Recall Interview

NATIONAL YOUTH PHYSICAL ACTIVITY AND NUTRITION STUDY

Documents and Forms

Document Name Document Type
Form 4 Student Contact Information for Dietary Recall Interview Form and Instruction
4 National Youth Physical Activity and Nutrition Study Stu Appendix E - Student Contact Form.doc Form and Instruction

Information Collection (IC) Details

IC Title:	Student Contact Information for Dietary Recall Interview	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	4	National Youth Physical Activity and Nutrition Study Student Contact Form	Appendix E - Student Contact Form.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09-20-0136, Epidemiologic Studies and Surveillance of Disease Problems	FR Citation: 57 FR 62812

Number of Respondents: 1,200	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	1,200	1,200
Annual IC Time Burden (Hours)	40	40
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.