Information Collection

Adult Survey

IC 262909 under ICR 202310-2528-003 · OMB 2528-0337.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2528-0337 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Final - Attachment M.1_The Obesity & Type II Diabetes Risk Asessment_Survey_Baseline.docx	Other-Adult Survey
Attachment M.1_The Obesity Type II Diabetes Risk Assessment_Survey_Baseline.docx	Other-Adult Survey
Final - Attachment M.2_The Obesity & Type II Diabetes Risk Assessment_Survey_Follow_up.docx	Other-Adult Survey
Attachment M.2_The Obesity Type II Diabetes Risk Assessment_Survey_Follow-up.docx	Other-Adult Survey

IC Title:

Adult Survey

Agency IC Tracking Number:

Is this a Common Form? No

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
Other-Adult Survey			Attachment M.1_The Obesity Type II Diabetes Risk Assessment_Survey_Baseline.docx		Yes	Yes	Fillable Fileable
Other-Adult Survey			Attachment M.2_The Obesity Type II Diabetes Risk Assessment_Survey_Follow-up.docx		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 900

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	1,800	1,800
Annual IC Time Burden (Hours)	1,800	1,800
Annual IC Cost Burden (Dollars)	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.