NATIONAL YOUTH PHYSICAL ACTIVITY AND NUTRITION STUDY

Forms and Documents

Document Name	Status
Form 4 Student Contact Information for Dietary Recall Interview Form and Instruction	New
Form 3 Student Physical Measurements Form	New
Form 2 NYPANS Student Questionnaire Form and Instruction	New
Form 1 Survey Support from Teachers Form	New
SS_PART_B_11.12.09[1].doc Supporting Statement B	2009-11-13
Appendix P - Data Collector Confidentiality Agreement.doc Supplementary Document	2009-06-16
Appendix O - List of Previously Fielded Questions.doc Supplementary Document	2009-06-16
Appendix N - Sample Table Shells.doc Supplementary Document	2009-06-16
Appendix M - IRB Approval.doc Supplementary Document	2009-06-16
Appendix L - Sampling and Weighting Plan.pdf Supplementary Document	2009-06-16
Appendix_K2_-_Parental_Permission_Form_Distribution_Script_-_NYPANS_and_24-Hour_Recall[1].doc Supplementary Document	2009-11-13
Appendix K1 - Parental Permission Form Distribution Script - NYPANS Only.doc Supplementary Document	2009-06-16
Appendix B2 - 60 Day FRN Comments.doc Supplementary Document	2009-06-16
Appendix F1 - Food Amounts Booklet.pdf Supplementary Document	2009-06-16
Appendix C8 - Parental Permission Form Reminnder Notice - Spanish.doc Supplementary Document	2009-06-16
Appendix C7 - Parental Permission Form Reminder Notice - English.doc Supplementary Document	2009-06-16
Appendix C6 - Parental Permission Form and Fact Sheet - NYPANS and 24-Hour Recall - Spanish.doc Supplementary Document	2009-06-16
Appendix_C5_-_Parental_Permission_Form_and_Fact_Sheet_-_NYPANS_and_24-Hour_Recall[1].doc Supplementary Document	2009-11-13
Appendix C4 - Parental Permission Form and Fact Sheet - NYPANS Only - Spanish.doc Supplementary Document	2009-06-16
Appendix C3 - Parental Permission Form and Fact Sheet - NYPANS Only - English.doc Supplementary Document	2009-06-16
Appendix_C2_-_Questionnaire_Administration_Guide_-_NYPANS_and_24-Hour_Recall[1].doc Supplementary Document	2009-11-13
Appendix C1 - Questionnaire Administration Guide - NYPANS Only.doc Supplementary Document	2009-06-16
Appendix J1 - Letter to Teachers in Particpating Classes.doc Supplementary Document	2009-06-16
Appendix_I2_-_School_Fact_Sheet[1].doc Supplementary Document	2009-11-13
Appendix I1 - School Letter of Invitation.doc Supplementary Document	2009-06-16
Appendix I3 - Letter to Agreeing Schools.doc Supplementary Document	2009-06-16
Appendix H1 - District Letter of Invitation.doc Supplementary Document	2009-06-16
Appendix G1 - State Letter of Invitation.doc Supplementary Document	2009-06-16
SS_PART_A_11.12[1].doc Supporting Statement A	2009-11-13

IC Document Collections

IC ID	Document Title	Status
189801	Student 24-Hour Dietary Recall Instruction	New
189800	Student Contact Information for Dietary Recall Interview Form and Instruction	New
189799	Student Physical Measurements Form	New
189798	NYPANS Student Questionnaire Form and Instruction	New
189797	Survey Support from Teachers Form	New
189796	Recruitment of Schools Instruction	New
189795	Recruitment of States Instruction	New
189794	Recruitment of States Instruction	New

ICR Details

OMB Control No: 0920-0832	ICR Reference No: 200907-0920-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: NATIONAL YOUTH PHYSICAL ACTIVITY AND NUTRITION STUDY
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 11/16/2009
	Date Received in OIRA: 07/02/2009
Terms of Clearance: This package is approved consistent with revised documents and based on a commitment by the Program to collaborate with NCI and ERS researchers working in the area of dietary assessment to develop an approach for cross-walking the results of this survey with their surveys, including the results of the NCI/NHANES survey: http://riskfactor.cancer.gov/studies/nhanes/nhanes_dtq_en.pdf.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2010	12 Months From Approved
Responses	20,080	0	0
Time Burden (Hours)	7,781	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: CDC proposes to conduct a study in Spring 2010 involving a nationally representative sample of students attending public and private schools in grades 9-12. The study will provide data on behaviors and behavioral determinants related to physical activity and nutrition, as well as information to help improve questions on the Youth Risk Behavior Survey. Study results will be used to develop more effective interventions for obesity.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 6164	02/05/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 29215	06/19/2009
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 8

IC Title	Form No.	Form Name
Recruitment of States
Recruitment of States
Recruitment of Schools
Survey Support from Teachers	1	Data Collection Checklist - NYPANS
NYPANS Student Questionnaire	2	National Youth Physical Activity and Nutrition Survey
Student Physical Measurements	3	National Youth Physical Activityand Nutrition Survey Height and Weight Record Form
Student Contact Information for Dietary Recall Interview	4	National Youth Physical Activity and Nutrition Study Student Contact Form
Student 24-Hour Dietary Recall

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	20,080	0	0	20,080	0	0
Annual Time Burden (Hours)	7,781	0	0	7,781	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new request to collect nationally representative information involving a student survey as well as physical measurements of height and weight. The information is not available on the study population from other sources. The present request is for a one-time information collection. A follow-up study may be conducted in approximately 4-5 years.

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Annual Cost to Federal Government: $584,577

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 07/02/2009

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