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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.