Information Collection

Adults- Sleep and Intake Questionnaire

IC 209129 under ICR 201310-0925-003 · OMB 0925-0692.

Documents and Forms

Document Name Document Type
Form 7 Adults- Sleep and Intake Questionnaire Form
7 Adu;ts Sleep and Intake Questionnaire Attachment 3 Sleep and Food Intake Survey.doc Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Adults- Sleep and Intake Questionnaire	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	7	Adu;ts Sleep and Intake Questionnaire	Attachment 3 Sleep and Food Intake Survey.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title: SORN	FR Citation: 67 FR 60741

Number of Respondents: 72	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	144	144
Annual IC Time Burden (Hours)	7	7
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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