Information Collection

NIH Diet and Health Study Questionnaire

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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 NIH Diet and Health Study Questionnaire 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:

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	1				Yes	No	Paper Only

Federal Enterprise Architecture Business Reference Module

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 %

table that charts list of burden
	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

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.

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