Reporting: Cognitive Interview Screener

Comparing Nutrition Knowledge, Attitude, and Behavior Among English Dominant Hispanics, Spanish Dominant Hispanics, and Other Consumers

Documents and Forms

Document Name Document Type
Appendix A Hispanic study draft questionnaire 0611.doc Other-Survey Questionnaire
0910-0706 final instrument English.pdf Other-english screen shots
0910-0706 final instrument Spanish.pdf Other-spanish screen shots

Information Collection (IC) Details

IC Title:	Reporting: Cognitive Interview Screener	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
Other-Survey Questionnaire	Appendix A Hispanic study draft questionnaire 0611.doc	Yes	Yes	Fillable Printable
Other-english screen shots	0910-0706 final instrument English.pdf	Yes	No	Paper Only
Other-spanish screen shots	0910-0706 final instrument Spanish.pdf	Yes	No	Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 72	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	72	72
Annual IC Time Burden (Hours)	6	6
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.