Information Collection

Automated Self-Administered 24-hour Recall (ASA24) for FORCS

IC 190234 under ICR 201107-0925-003 · OMB 0925-0605.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 4 Automated Self-Administered 24-hour Recall (ASA24) for FORCS	Form and Instruction
4 Automated Self-Administered 24-hour Recall (ASA24) Attach 2 - ASA24 Screenshots 11-0330.docx asa24.westat.com/	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Automated Self-Administered 24-hour Recall (ASA24) for FORCS

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	4	Automated Self-Administered 24-hour Recall (ASA24)	Attach 2 - ASA24 Screenshots 11-0330.docx	http://asa24.westat.com/	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title: 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: 400

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	400	-86	486
Annual IC Time Burden (Hours)	200	-43	243
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.