Information Collection

2020 Dietary Primer Assessment and Feedback (NCI)

IC 244041 under ICR 202002-0925-002 · OMB 0925-0642.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0642 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 2020 Dietary Primer Assessment and Feedback (NCI)	Form
1 Dietary Primer survey Primer Survey.docx	Form
Fast Track Request-Dietary Assessment Primer.docx 2020 Dietary Assessment Primer Survey fast track	IC Document
Email.docx email	IC Document

IC Title:

2020 Dietary Primer Assessment and Feedback (NCI)

Agency IC Tracking Number:

IC Status: New

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	1	Dietary Primer survey	Primer Survey.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 100

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	25	25
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
2020 Dietary Assessment Primer Survey fast track	Fast Track Request-Dietary Assessment Primer.docx	10/13/2020
email	Email.docx	10/13/2020

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