0920-1316 Reocrd of time spent outdoors

Attachment 11

Record of Time Spent Outdoors

Form Approved

OMB No. 0920-0079

Exp. Date XX/XX/XXXX

Record of Time Spent Outdoors

CDC estimates the average public reporting burden for this collection of information as 5 minutes per response, including the time for reviewing instructions, searching existing data/information sources, gathering and maintaining the data/information needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-0079).

Form Approved

OMB No. 0920-xxxx

Exp. Date XX/XX/XXXX

Study ID _______________________________ Date ________________

Aerosols from cyanobacterial blooms: Exposures and health effects in highly exposed populations

Record of Time Spent Outdoors

Instructions: Please fill in the time you have spent outdoors today in the table below. The table is in two parts, one for the morning and one for the afternoon and night. Each hour is divided into 15-minute intervals. Using a pencil or pen, blacken the 15-minute intervals where you spent at least part of that time outdoors. Do not count time riding in a car (bus, train, etc.) as time spent outdoors.

3 pm

For example, if you were outside from about 3 pm to 3:15 pm, and again from 3:30 to 3:45, you would complete the section in the AFTERNOON AND NIGHT table like this:

Time (MORNING)

Midnight

1 am

2 am

3 am

4 am

5 am

6 am

7 am

8 am

9 am

10 am

11 am

Time (AFTERNOON AND NIGHT)

Noon

1 pm

2 pm

3 pm

4 pm

5 pm

6 pm

7 pm

8 pm

9 pm

10 pm

11 pm

NOTE: It would be nice to give everyone a marker on each visit so they can easily complete the table with just one swipe for each 15-minute interval.

CDC estimates the average public reporting burden for this collection of information as 10 minutes per response, including the time for reviewing instructions, searching existing data/information sources, gathering and maintaining the data/information needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-xxxx).