Information Collection

Adult Activity Diary and Reminder

IC 203630 under ICR 201208-0920-003 · OMB 0920-0977.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0977 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Adult Activity Diary and Reminder	Form
Att 13D_Accelerometry Reminder.docx	Other-Email Reminder
Att S13D_Accel Reminder Spanish.docx	Other-Email Reminder
Adult Activity Diary Att 13B_Adult Activity Diary.docx	Form
Spanish Adult Activity Diary Att S13B_Adult Diary Spanish.docx	Form
Att 13A_Accelerometry Instructions.docx Accelerometry Instructions	IC Document
Att S13A_Accelerometry Instructions Spanish.docx Spanish Accelerometry Instructions	IC Document

IC Title:

Adult Activity Diary and Reminder

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Adult Activity Diary	Att 13B_Adult Activity Diary.docx	Yes	No	Fillable Fileable
Other-Email Reminder			Att 13D_Accelerometry Reminder.docx	Yes	No	Fillable Fileable
Form	none	Spanish Adult Activity Diary	Att S13B_Adult Diary Spanish.docx	Yes	Yes	Fillable Fileable
Other-Email Reminder			Att S13D_Accel Reminder Spanish.docx	Yes	No	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title: Epidemiologic Studies and Surveillance of Disease Problems

FR Citation: 57 FR 62812

Number of Respondents: 500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	167	167
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Accelerometry Instructions	Att 13A_Accelerometry Instructions.docx	08/07/2012
Spanish Accelerometry Instructions	Att S13A_Accelerometry Instructions Spanish.docx	08/07/2012

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.