Information Collection

Adolescent Physical Activity Survey Instrument (Attachment I)

IC 208731 under ICR 201403-0925-004 · OMB 0925-0686.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 5 Adolescent Physical Activity Survey Instrument (Attachment I)	Form and Instruction
5 Adolescent Physical Activity Survey Attach1_Teen Physical Activity Survey REV 2104.docx www.research-survey.org/efm/wsb.dll/s/1g3e	Form and Instruction

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 and Instruction	5	Adolescent Physical Activity Survey	Attach1_Teen Physical Activity Survey REV 2104.docx	https://www.research-survey.org/efm/wsb.dll/s/1g3e	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title: Clinical, Basic, Population-based Research Studies of the National Institutes of Health

FR Citation: 67 FR 60776

Number of Respondents: 1,250

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	1,250	1,250
Annual IC Time Burden (Hours)	417	417
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.