Information Collection

NIH Diet and Health Study Questionnaire

IC 183704 under ICR 201104-0925-001 · OMB 0925-0587.

Documents and Forms

Document Name Document Type
Form 1 NIH Diet and Health Study Questionnaire Form and Instruction
1 NIH Diet and Health Study Questionnaire Att2_NIH-AARP_short questionniare.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	NIH Diet and Health Study Questionnaire	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	1	NIH Diet and Health Study Questionnaire	Att2_NIH-AARP_short questionniare.pdf		Yes	No	Paper Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title: SORN #09-25-0156, "Records of Participants in Programs and Respondents in Surveys Used to Evaluate Programs of the Public Health Service, HHS/PHS/NIH/OD"	FR Citation: 67 FR 60743

Number of Respondents: 485,909	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	485,909	-27,316	513,225
Annual IC Time Burden (Hours)	32,394	-1,821	34,215
Annual IC Cost Burden (Dollars)	0	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.