Information Collection

Block Food Frequency Questionnaire

IC 219655 under ICR 201805-0920-009 · OMB 0920-1115.

Documents and Forms

Document Name Document Type
Form 0920-15BEB Block Food Frequency Questionnaire Form and Instruction
0920-15BEB Attachment 9_Block 2005 FFQ Screenshots_English Attachment 9_Block 2005 FFQ Screenshots_English.pdf Form and Instruction
0920-15BEB Attachment 9s_Block 2005 FFQ Screenshots_Spanish Attachment 9s_Block 2005 FFQ Screenshots_Spanish.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Block Food Frequency Questionnaire	Agency IC Tracking Number:	0920-1115

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-15BEB	Attachment 9_Block 2005 FFQ Screenshots_English	Attachment 9_Block 2005 FFQ Screenshots_English.pdf		Yes	No	Fillable Printable
Form and Instruction	0920-15BEB	Attachment 9s_Block 2005 FFQ Screenshots_Spanish	Attachment 9s_Block 2005 FFQ Screenshots_Spanish.pdf		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 63	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	284	-31	315
Annual IC Time Burden (Hours)	85	-10	95
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.