Information Collection

Formative - Developmental

IC 193580 under ICR 201107-0925-001 · OMB 0925-0593.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0593 can be found here:

Documents and Forms

Document Name Document Type
Burden 19 HiLo Household Inventory Questionnaire 20110420 - LOIx-QUEX-01-B-1.DOCX Instruction
Burden 20 Participant Internet Usage and Contact Preference Survey 20110420 - LOI2-INF-17.docx Instruction
Burden 125 Exemplar Demographics 20110621 - LOI3-PHYS-02.docx Instruction
Burden 250 Measurement Form 20110621 - LOI3-PHYS-02.pdf Instruction
Burden 38 Contact Info 20110621 - LOI3-PHYS-01.docx Instruction
Burden 38 Exit Survey 20110621 - LOI3-PHYS-01.docx Instruction
Burden 38 Visit Screen 20110621 - LOI3-PHYS-01.docx Instruction
Burden 75 Questionnaire 20110621 - LOI3-PHYS-01.docx Instruction
Burden 15 Acculturation Instrument 20110621 - LOI2-QUEX-14.docx Instruction
Burden 37 Second Acceptability Questionnaire 20110621 - LOI2-QUEX-14.doc Instruction
Burden 38 Initial Acceptability Questionnaire 20110621 - LOI2-QUEX-14.doc Instruction
Burden 90 Food Record 20110621 - LOI2-QUEX-14.docx Instruction
Burden 100 NCS FFQ 20110621 - LOI2-QUEX-14.pdf Instruction
Burden 38 Screening 20110621 - LOI3-PHYS-01.docx Instruction
Burden 250 NCS ASA24 Protocol (Placeholder for web survey) 20110621 - LOI2-QUEX-14.docx Instruction
Note to File - Formative Research (updated 20110617).docx Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Formative - Developmental	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction	Burden 19 HiLo Household Inventory Questionnaire 20110420 - LOIx-QUEX-01-B-1.DOCX	Yes	Yes	Paper Only
Instruction	Burden 20 Participant Internet Usage and Contact Preference Survey 20110420 - LOI2-INF-17.docx	Yes	Yes	Paper Only
Instruction	Burden 125 Exemplar Demographics 20110621 - LOI3-PHYS-02.docx	Yes	Yes	Paper Only
Instruction	Burden 250 Measurement Form 20110621 - LOI3-PHYS-02.pdf	Yes	Yes	Paper Only
Instruction	Burden 38 Contact Info 20110621 - LOI3-PHYS-01.docx	Yes	Yes	Paper Only
Instruction	Burden 38 Exit Survey 20110621 - LOI3-PHYS-01.docx	Yes	Yes	Paper Only
Instruction	Burden 38 Visit Screen 20110621 - LOI3-PHYS-01.docx	Yes	Yes	Paper Only
Instruction	Burden 75 Questionnaire 20110621 - LOI3-PHYS-01.docx	Yes	Yes	Paper Only
Instruction	Burden 15 Acculturation Instrument 20110621 - LOI2-QUEX-14.docx	Yes	Yes	Paper Only
Instruction	Burden 37 Second Acceptability Questionnaire 20110621 - LOI2-QUEX-14.doc	Yes	Yes	Paper Only
Instruction	Burden 38 Initial Acceptability Questionnaire 20110621 - LOI2-QUEX-14.doc	Yes	Yes	Paper Only
Instruction	Burden 90 Food Record 20110621 - LOI2-QUEX-14.docx	Yes	Yes	Paper Only
Instruction	Burden 100 NCS FFQ 20110621 - LOI2-QUEX-14.pdf	Yes	Yes	Paper Only
Instruction	Burden 38 Screening 20110621 - LOI3-PHYS-01.docx	Yes	Yes	Paper Only
Instruction	Burden 250 NCS ASA24 Protocol (Placeholder for web survey) 20110621 - LOI2-QUEX-14.docx	Yes	Yes	Paper Only
Instruction	Note to File - Formative Research (updated 20110617).docx	Yes	Yes	Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: General Science and Innovation

Subfunction: Scientific and Technological Research and Innovation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 14,542	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	14,542	14,542
Annual IC Time Burden (Hours)	14,542	14,542
Annual IC Cost Burden (Dollars)	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.