Information Collection

Individuals

IC 7259 under ICR 201009-0925-002 · OMB 0925-0216.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0216 can be found here:

Documents and Forms

IC Title:

Individuals

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	10	Form	Food Frequency.doc	Yes	Yes	Paper Only
Form and Instruction	1	survey	Attach #1.doc	Yes	Yes	Paper Only
Form and Instruction	2	survey	Attach #2.docm	Yes	Yes	Paper Only
Form and Instruction	4	survey	Attach #4.docm	Yes	Yes	Paper Only
Form and Instruction	7	survey	Attach #7.docm	Yes	Yes	Paper Only
Form and Instruction	15	survey	Attach #15.docm	Yes	Yes	Paper Only
Form and Instruction	16	survey	Attach #16.rtf	Yes	Yes	Paper Only
Form and Instruction	17	survey	Attach #17.doc	Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 4,461

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	4,461	-763	5,224
Annual IC Time Burden (Hours)	4,442	-782	5,224
Annual IC Cost Burden (Dollars)	0	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.