Information Collection

Health and Diet Survey-General Topics : Screener

IC 183122 under ICR 201403-0910-009 · OMB 0910-0545.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0545 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0545_HDS_2011_-_Draft_questionnaire May 26.doc	Other-Survey
0545_HDS_2011_-_Draft_Dietary_Guidelines_questionnaire May 26.doc	Other-Survey

IC Title:

Health and Diet Survey-General Topics : Screener

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
Other-Survey			0545_HDS_2011_-_Draft_questionnaire May 26.doc		No	No	Paper Only
Other-Survey			0545_HDS_2011_-_Draft_Dietary_Guidelines_questionnaire May 26.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10,000

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	Previously Approved
Annual Number of Responses for this IC	10,000	10,000
Annual IC Time Burden (Hours)	200	200
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.