Information Collection

Youth Activity Diary - completed by youth

IC 203635 under ICR 201305-0920-002 · OMB 0920-0977.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Youth Activity Diary - completed by youth	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 Accelerometry Instructions - 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	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: 67

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	67	67
Annual IC Time Burden (Hours)	22	22
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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