Diet and Health History Questionnaire (DHQ)

interactive Comprehensive Lifestyle Interview by Computer (iCLIC) Study (NCI)

OMB: 0925-0594

IC ID: 186343

Information Collection (IC) Details

View Information Collection (IC)

Diet and Health History Questionnaire (DHQ)
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 4-4B DHQ instrument Att 4-4B_Instrument DHQ Paper Version.pdf http://riskfactor.cancer.gov/DHQ/ Yes Yes Fillable Fileable
Instruction Att 4-4A_DHQBurdenPage.pdf http://riskfactor.cancer.gov/DHQ/ Yes Yes Fillable Fileable

Health Public Health Monitoring

 

1,716 0
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1,716 0 0 680 0 1,036
Annual IC Time Burden (Hours) 1,287 0 0 510 0 777
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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