Automatic Self-Administered 24-hour Dietary Recall (ASA24) (Attach 4-1)

The NIH-AARP interactive Comprehensive Lifestyle Interview by Computer Study (iCLIC) (NCI)

Documents and Forms

Document Name Document Type
Form 2 Automatic Self-Administered 24-hour Dietary Recall (ASA24) (Attach 4-1) Form and Instruction
2 ASA24 Att 4-1A and 4-1B_Partial ASA24 w URL.docx asa24.westat.com Form and Instruction

Information Collection (IC) Details

IC Title:	Automatic Self-Administered 24-hour Dietary Recall (ASA24) (Attach 4-1)	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
Form and Instruction	2	ASA24	Att 4-1A and 4-1B_Partial ASA24 w URL.docx	http://asa24.westat.com	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: SORN #09-25-0200, "Clinical, Basic, and Population-based Research Studies of the National Institutes of Health (NIH), HHS/NIH/OD"	FR Citation: 67 FR 60776

Number of Respondents: 1,944	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	3,888	-948	4,836
Annual IC Time Burden (Hours)	1,944	-1,434	3,378
Annual IC Cost Burden (Dollars)	0	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.