Health and Diet Survey-General Topics : Screener

Health and Diet Survey

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0545 can be found here:

Documents and Forms

Document Name Document Type
0545_HDS_2011_-_Draft_questionnaire May 26.doc Other-Survey
0545_HDS_2011_-_Draft_Dietary_Guidelines_questionnaire May 26.doc Other-Survey

Information Collection (IC) Details

IC Title:	Health and Diet Survey-General Topics : Screener	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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
Other-Survey			0545_HDS_2011_-_Draft_questionnaire May 26.doc		No	No	Paper Only
Other-Survey			0545_HDS_2011_-_Draft_Dietary_Guidelines_questionnaire May 26.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	10,000	10,000
Annual IC Time Burden (Hours)	200	200
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.