Information Collection

Actigraphy*

IC 266351 under ICR 202403-0920-015 · OMB 0920-1436.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1436 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-23HM Actigraphy* Form
0920-23HM Actigraphy Attachment 4a - Statement of Actiwatch return_Fatigue OGE.docx Form
0920-23HM Actigraphy Attachment 4a - Statement of Actiwatch return_Fatigue OGE.docx Form
0920-23HM Actigraphy_Spanish Attachment 4b - Statement of Actiwatch return_Fatigue OGE - ES.docx Form
0920-23HM Actigraphy_Spanish Attachment 4b - Statement of Actiwatch return_Fatigue OGE - ES.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Actigraphy*	Agency IC Tracking Number:	0920-23HM

Is this a Common Form? Yes		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	0920-23HM	Actigraphy	Attachment 4a - Statement of Actiwatch return_Fatigue OGE.docx		Yes	Yes	Fillable Fileable
Form	0920-23HM	Actigraphy_Spanish	Attachment 4b - Statement of Actiwatch return_Fatigue OGE - ES.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 80	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	80	80
Annual IC Time Burden (Hours)	20	20
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.