Information Collection Request

Interactive Diet and Activity Tracking in AARP (iDATA): Biomarker Based Validation Study (NCI)

ICR 201105-0925-003 · OMB 0925-0640 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 22 Att.34 ACT24 Form New Available
Form 21 Att.33 DHQ Form New Available
Form 20 Att.32 ASA24 Form New Repair queued
Form 19 Att.22 Stanford Physical Activity Screener Form New Source copy available
Form 18 Att.21 Sedentary Behavior Questionnaire Form New Available
Form 17 Att.20 AARP Physical Activity questions Form New Available
Form 16 Att.19 CHAMPS Activities Questionnaire Form New Available
Form 15 Att.18 Harvard Lifestyle Questionnaire for iDATA Form New Available
Form 14 Att.17 4 Day Food Record iDATA Form and Instruction New Available
Form 13 Att.16 7-Day Food Checklist iDATA Form and Instruction New Available
Form 12 Att.15 Saliva collection instructions Form and Instruction New Available
Form 11 Att.14 24 hr Urine Collection Log Form and Instruction New Available
Form 10 Att.13 Anthropometry Form New Available
Form 9 Att.12 PA Monitor Log Form and Instruction New Available
Form 8 Att.11A and 11B PARQ PARmedX Form New Available
Form 7 Att 10 FitnessTest protocol Form New Available
Form 6 Att 8 Heart Rate Monitor Log Form and Instruction New Available
Form 5 Att 7 RMR Protocol Form and Instruction New Repair queued
Form 4 Att 6 DLW Protocol and Form.doc Form New Available
Form 3 Att 5 Fasting Blood Protocol and Form Form and Instruction New Available
Form 2 Att 3 Clinic Eligibility Screening Interview Form New Available
Form 1 Att 1 Pre-Screening Telephone Interview Form New Available
SSB iDATA_5-5-2011.docx Supporting Statement B Uploaded 2011-05-10 Available
Att.29 NCI & Westat IRB Approval.pdf Supplementary Document Uploaded 2011-05-13 Available
Att.31 Email Invite to New AARP Members.docx Supplementary Document Uploaded 2011-05-10 Available
Att.30B Invitation letters New AARP Members.docx Supplementary Document Uploaded 2011-05-10 Available
Att.30A Invitation letters AARP Cohort.docx Supplementary Document Uploaded 2011-05-10 Available
Att.27 Westat Procedures for Keeping Data Confidential.doc Supplementary Document Uploaded 2011-05-10 Available
Att.26 Privacy Act Memo.pdf Supplementary Document Uploaded 2011-05-10 Available
Att.28 Confidentiality Statement.pdf Supplementary Document Uploaded 2011-05-10 Available
Att.25 External Scientific Consultants.docx Supplementary Document Uploaded 2011-05-10 Available
Att.24 iDATA Study Advisory Group Members.docx Supplementary Document Uploaded 2011-05-10 Available
Att.23 PIA.docx Supplementary Document Uploaded 2011-05-10 Available
Att.9 Informed Consent substudy.doc Supplementary Document Uploaded 2011-05-10 Available
Att.4B Informed Consent main study-new members.doc Supplementary Document Uploaded 2011-05-10 Available
Att.4A Informed Consent main study-AARP cohort.doc Supplementary Document Uploaded 2011-05-10 Available
Att.2 iDATA Study Brochure.docx Supplementary Document Uploaded 2011-05-10 Available
Cover Memo_iDATA.doc Supplementary Document Uploaded 2011-05-10 Available
SSA iDATA_5-13-2011.docx Supporting Statement A Uploaded 2011-05-13 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
197738 Att.34 ACT24 Form New
197737 Att.33 DHQ Form New
197736 Att.32 ASA24 Form New
197735 Att.22 Stanford Physical Activity Screener Form New
197734 Att.21 Sedentary Behavior Questionnaire Form New
197733 Att.20 AARP Physical Activity questions Form New
197732 Att.19 CHAMPS Activities Questionnaire Form New
197731 Att.18 Harvard Lifestyle Questionnaire for iDATA Form New
197730 Att.17 4 Day Food Record iDATA Form and Instruction New
197729 Att.16 7-Day Food Checklist iDATA Form and Instruction New
197728 Att.15 Saliva collection instructions Form and Instruction New
197727 Att.14 24 hr Urine Collection Log Form and Instruction New
197726 Att.13 Anthropometry Form New
197725 Att.12 PA Monitor Log Form and Instruction New
197724 Att.11A and 11B PARQ PARmedX Form New
197723 Att 10 FitnessTest protocol Form New
197722 Att 8 Heart Rate Monitor Log Form and Instruction New
197721 Att 7 RMR Protocol Form and Instruction New
197720 Att 6 DLW Protocol and Form.doc Form New
197719 Att 5 Fasting Blood Protocol and Form Form and Instruction New
197718 Att 3 Clinic Eligibility Screening Interview Form New
197717 Att 1 Pre-Screening Telephone Interview Form New

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
08/31/2014 36 Months From Approved
34,826 0 0
15,061 0 0
0 0 0





Reginfo record details
22
table that charts list of burden
IC Title Form No. Form Name
Att.34 ACT24 22 Att.34 ACT24
Att 1 Pre-Screening Telephone Interview 1 Att 1 Pre-Screening Telephone Interview
Att 3 Clinic Eligibility Screening Interview 2 Att 3 Clinic Eligibility Screening Interview
Att 5 Fasting Blood Protocol and Form 3 Att 5 Fasting Blood Protocol and Form
Att 6 DLW Protocol and Form.doc 4 Att 6 DLW Protocol and Form.doc
Att 7 RMR Protocol 5 Att 7 RMR Protocol
Att 8 Heart Rate Monitor Log 6 Att.8 Heart Rate Monitor Log
Att 10 FitnessTest protocol 7 Att 10 FitnessTest protocol
Att.15 Saliva collection instructions 12 Att.15 Saliva collection instructions
Att.16 7-Day Food Checklist iDATA 13 Att.16 7-Day Food Checklist iDATA
Att.19 CHAMPS Activities Questionnaire 16 Att.19 CHAMPS Activities Questionnaire
Att.20 AARP Physical Activity questions 17 Att.20 AARP PA questions
Att.21 Sedentary Behavior Questionnaire 18 Att.21 Sedentary Behavior Questionnaire
Att.17 4 Day Food Record iDATA 14 Att.17 4 Day Food Record iDATA
Att.18 Harvard Lifestyle Questionnaire for iDATA 15 Att.18 Harvard Lifestyle Questionnaire for iDATA
Att.12 PA Monitor Log 9 Att.12 PA Monitor Log
Att.22 Stanford Physical Activity Screener 19 Att.22 Stanford Physical Activity Screener
Att.32 ASA24 20 Att.32 ASA24
Att.11A and 11B PARQ PARmedX 8 Att.11A and 11B PARQ PARmedX
Att.13 Anthropometry 10 Att.13 Anthropometry
Att.14 24 hr Urine Collection Log 11 Att.14 24 hr Urine Collection Log
Att.33 DHQ 21 Att.33 DHQ

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 34,826 0 0 34,826 0 0
Annual Time Burden (Hours) 15,061 0 0 15,061 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No