Information Collection

Generic Sub-study: Reliability Testing for Survey Questions about the Walking Environment

IC 215184 under ICR 201404-0925-003 · OMB 0925-0589.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0589 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Generic Sub-study: Reliability Testing for Survey Questions about the Walking Environment	Form and Instruction
1 Appendix A Final Walking Environment First Appendix A Final Walking Environment First.pdf	Form and Instruction
2 Appendix B Final Walking Behaviors First Appendix B Final Walking Behaviors First.pdf	Form and Instruction
3 Appendix C Final Random Order Appendix C Final Random Order.pdf	Form and Instruction
4 Appendix D Final Cognitive Probes Appendix D Final Cognitive Probes.pdf	Form and Instruction
NCI Mini SSB Final.docx Mini SSB	IC Document
NCI Mini SSA Final KB-1.docx Mini SSA	IC Document

IC Title:

Generic Sub-study: Reliability Testing for Survey Questions about the Walking Environment

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Appendix A Final Walking Environment First	Appendix A Final Walking Environment First.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	2	Appendix B Final Walking Behaviors First	Appendix B Final Walking Behaviors First.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	3	Appendix C Final Random Order	Appendix C Final Random Order.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	4	Appendix D Final Cognitive Probes	Appendix D Final Cognitive Probes.pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,500	1,500
Annual IC Time Burden (Hours)	274	274
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Mini SSB	NCI Mini SSB Final.docx	02/23/2015
Mini SSA	NCI Mini SSA Final KB-1.docx	02/24/2015

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