Form 1 ANT-Anthropometry

Public reporting burden for this collection of information is estimated to average 7
minutes per response, including the time for reviewing instructions, searching existing
data sources, gathering and maintaining the data needed, and completing and reviewing
the collection of information. An agency may not conduct or sponsor, and a person is
not required to respond to, a collection of information unless it displays a currently
valid OMB control number. Send comments regarding this burden estimate or any other
aspect of this collection of information, including suggestions for reducing this
burden, to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD
20892-7974, ATTN: PRA (0925-0584). Do not return the completed form to this address.

OMB#: 0925-0584
Exp. xx/xx/xxxx

HCHS/SOL Anthropometry
FORM CODE: ANT
VERSION: 1, 12/10/2013

ID NUMBER:

Contact
0
Occasion

2

SEQ #

ADMINISTRATIVE INFORMATION

/

0a. Completion Date:
Month

/
Day

0b. Staff ID:
Year

Instructions: Enter the answer given by the participant for each response. If the response is unknown, use the
CDART Notelog window to code 'Don’t know/refused, Missing, etc.' for those questions. In order to measure
bioimpedence, the participant must be barefoot. Set the Tanita analyzer to report metric units (cm/kg).

A. DETERMINATION OF ABILITY TO STAND
1. Assessment of ability to stand (choose one): ...........................
Can stand erectly on both feet. .............................................. 1
Can stand on both feet, but posture not erect. ....................... 2
Cannot stand on both feet. ..................................................... 3  GO TO ITEM 10
B. HEIGHT, WEIGHT, and BIO-IMPEDENCE
2. Standing height (round to nearest cm): .....................................

cm

3. a) Self-reported weight (to the nearest lb or kg): ......................
b) Units (check one): .........................................................................

lb

kg

.

4. Weight: ....................................................................................
5. Fat (%): ....................................................................................

.

%

6. Impedance: ..............................................................................
7. Fat mass: .................................................................................
8. Lean body mass (FFM): ...........................................................
9. Total body water (TBW): ..........................................................

kg

Ohms

.
.
.

kg
kg
kg

C. BODY SIZE
10. Girth (round to nearest cm)
a) Waist: ..................................................................................

cm

b) Hip: ......................................................................................

cm

ANT-Anthropometry_12-10-2013.doc

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