Information Collection

Adult Diet Survey Instrument (Attachment J)

IC 208732 under ICR 201403-0925-004 · OMB 0925-0686.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 6 Adult Diet Survey Instrument (Attachment J)	Form
6 Adult Diet Survey Intrument (Attachment J) Attach J - Adult Diet Instrument.docx https:/www.research-survey.org/efm/wsb.dll/s/1g3c	Form

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	6	Adult Diet Survey Intrument (Attachment J)	Attach J - Adult Diet Instrument.docx	https:/www.research-survey.org/efm/wsb.dll/s/1g3c	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)	313	313
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.