Information Collection

Youth Activity Diary - completed by caregiver

IC 203633 under ICR 201305-0920-002 · OMB 0920-0977.

Documents and Forms

Document Name Document Type
Youth Activity Diary - completed by caregiver Form
Youth Activity Diary Att 13C_YouthActivityDiary.docx Form
Youth Activity Diary - Spanish Att 13C-S_YouthActivityDiary_SP.doc Form
Att 13A_AccelInstructions.docx Accelerometry Instructions IC Document
Att 13A-S_AccelInstructions_SP.docx Acceleromtery Instructions - Spanish IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Youth Activity Diary - completed by caregiver	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	Youth Activity Diary	Att 13C_YouthActivityDiary.docx		No	No	Paper Only
Form	none	Youth Activity Diary - Spanish	Att 13C-S_YouthActivityDiary_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: 100	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	100	100
Annual IC Time Burden (Hours)	33	33
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Accelerometry Instructions	Att 13A_AccelInstructions.docx	04/22/2013
Acceleromtery Instructions - 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.