Information Collection

Adult Activity Diary

IC 203630 under ICR 201305-0920-002 · OMB 0920-0977.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Adult Activity Diary	Form
Adult Activity Diary Att 13B_AdultActivityDiary.doc	Form
Adult Activity Diary - Spanish Att 13B-S_AdultActivityDiary_SP.doc	Form
Att 13A_AccelInstructions.docx Instructions for Accelerometry	IC Document
Att 13A-S_AccelInstructions_SP.docx Instructions for Accelerometry - Spanish	IC Document

IC Title:

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	none	Adult Activity Diary	Att 13B_AdultActivityDiary.doc		No	No	Paper Only
Form	none	Adult Activity Diary - Spanish	Att 13B-S_AdultActivityDiary_SP.doc		No	No	Paper Only

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: 167

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	167	167
Annual IC Time Burden (Hours)	56	56
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Instructions for Accelerometry	Att 13A_AccelInstructions.docx	04/22/2013
Instructions for Accelerometry - Spanish	Att 13A-S_AccelInstructions_SP.docx	04/22/2013

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