Information Collection

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

IC 215184 under ICR 201511-0925-002 · OMB 0925-0589.

Documents and Forms

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

Agency IC Tracking Number:

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Yes	Yes	Fillable Fileable
Form and Instruction	2	Yes	Yes	Fillable Fileable
Form and Instruction	3	Yes	Yes	Fillable Fileable
Form and Instruction	4	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
	Requested	Previously Approved
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		02/23/2015
Mini SSA		02/24/2015

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

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