Information Collection

Physical Activity Subsample Study

IC 210034 under ICR 201407-0925-005 · OMB 0925-0593.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 42.1 Physical Activity Subsample Study	Form and Instruction
PhysicalActivityGPSMonitorShippingInstructions.docx	Instruction
42.1 Survey PhysicalActivityMonitorSAQ.docx	Form and Instruction
42.2 Survey PhysicalActivityMonitorPickUpInstrument.docx	Form and Instruction
42.3 Survey PhysicalActivityMonitorLogSAQ.docx	Form and Instruction
42.4 Survey PhysicalActivityMonitorSetUpInstrument.docx	Form and Instruction
PhysicalActivityMonitorGPSInstructions.docx PhysicalActivityMonitorGPSInstructions	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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	42.1	Survey	PhysicalActivityMonitorSAQ.docx	Yes	Yes	Paper Only
Form and Instruction	42.2	Survey	PhysicalActivityMonitorPickUpInstrument.docx	Yes	Yes	Paper Only
Form and Instruction	42.3	Survey	PhysicalActivityMonitorLogSAQ.docx	Yes	Yes	Paper Only
Form and Instruction	42.4	Survey	PhysicalActivityMonitorSetUpInstrument.docx	Yes	Yes	Paper Only
Instruction			PhysicalActivityGPSMonitorShippingInstructions.docx	Yes	Yes	Paper Only

Line of Business: General Science and Innovation

Subfunction: Scientific and Technological Research and Innovation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200

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	600	600
Annual IC Time Burden (Hours)	430	430
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
PhysicalActivityMonitorGPSInstructions	PhysicalActivityMonitorGPSInstructions.docx	11/07/2013

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