Adult Activity Diary

Targeted Surveillance and Biometric Studies for Enhanced Evaluation of CTGs

Documents and Forms

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

Information Collection (IC) Details

IC Title:	Adult Activity Diary	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection 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 %

	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

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.