Information Collection

Young Adults

IC 190911 under ICR 201211-0925-007 · OMB 0925-0610.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0610 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Young Adults	Form and Instruction
Attachment 7 Physical Activity Recall 2012.doc	Instruction
1 Participant Online Survey Attachment 1B - Participant Online Survey Screenshots.pdf	Form and Instruction
Attachment 1A Participant Hard Copy Survey 2012.doc Attachment 1A Participant Hard Copy Survey 2012	IC Document

IC Title:

Young Adults

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	1	Participant Online Survey	Attachment 1B - Participant Online Survey Screenshots.pdf		Yes	Yes	Fillable Fileable
Instruction			Attachment 7 Physical Activity Recall 2012.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,100

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	2,100	-600	2,700
Annual IC Time Burden (Hours)	2,100	75	2,025
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment 1A Participant Hard Copy Survey 2012	Attachment 1A Participant Hard Copy Survey 2012.doc	11/14/2012

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