Formative - Developmental

ATTACHMENT C.2.4
OMB Number: 0925-0593
Expiration Date: July 13, 2013

LOI3-PHYS-02 EXEMPLAR MEASUREMENT FORM

Anthropometry in Children
Data Collection Form
Participant Name:
Participant ID:
Participant Sex:
Participant DOB:
Today’s Date:

Field Measurements
Data Collector 1:
Measurement
Length/Height (mm) circle
Ulna Measurement (mm)
Tibia Measurement (mm)
Data Collector 2:
Measurement
Length/Height (mm) circle
Ulna Measurement (mm)
Tibia Measurement (mm)
DXA Measurements
Measurement
Ulna Measurement (mm)
Tibia Measurement (mm)

Measure 1

Measure 2

Measure 3

Measure 1

Measure 2

Measure 3

DXA Measurement

Date & Initials Entered C#1
Date & Initials Entered C#2

NOTIFICATION TO RESPONDENT OF ESTIMATED BURDEN
Public reporting burden for this collection of information is estimated to average 10 minutes per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency
may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control
number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this
burden, to: NIH, Project Clearance Office, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7479, ATTN: PRA (0925-0593*). Do not return the
completed form to this address.