Information Collection

Block Food Frequency Questionnaire

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

Documents and Forms

Documents and forms in this information collection
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

IC Title:

Agency IC Tracking Number:

0920-1115

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.