Information Collection

Cognitive Testing of the ATUS Eating and Health Module

IC 248221 under ICR 202009-1220-006 · OMB 1220-0141.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1220-0141 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Appendix D Cognitive Testing of the ATUS Eating and Health Module	Form and Instruction
Appendix D ATUS Eating and Health Module Survey Protocol Appendix D-ATUS Eating and Health Module Protocol 4-1-21.docx	Form and Instruction
Appendix A Eating and Health Module Questionnaire Appendix A-EHM questionnaire 2022-23 4-1-2021.docx	Form
Note to Review - Cognitive testing for the ATUS Eating and Health Module....docx Note to Reviewer - ATUS Eating and Health Module	IC Document

IC Title:

Cognitive Testing of the ATUS Eating and Health Module

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 and Instruction	Appendix D	ATUS Eating and Health Module Survey Protocol	Appendix D-ATUS Eating and Health Module Protocol 4-1-21.docx		Yes	No	Fillable Printable
Form	Appendix A	Eating and Health Module Questionnaire	Appendix A-EHM questionnaire 2022-23 4-1-2021.docx		Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 75

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
Annual Number of Responses for this IC	75	75
Annual IC Time Burden (Hours)	34	34
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Note to Reviewer - ATUS Eating and Health Module	Note to Review - Cognitive testing for the ATUS Eating and Health Module....docx	07/06/2021

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