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2006 Hispanic/Latino Adult Tobacco Survey
2006 Hispanic/Latino Adult Tobacco Survey
OMB: 0920-0726
IC ID: 43616
OMB.report
HHS/CDC
OMB 0920-0726
ICR 200707-0920-007
IC 43616
( )
Documents and Forms
Document Name
Document Type
H-L ATS Questionnaire (English)_El_Paso.doc
Instruction
H-L ATS Questionnaire (All Spanish)_El_Paso.doc
Instruction
H-L ATS Questionnaire tracked changes.doc
Tracked change instrument
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
2006 Hispanic/Latino Adult Tobacco Survey
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
Instruction
H-L ATS Questionnaire (All Spanish)_El_Paso.doc
Yes
Yes
Printable Only
Instruction
H-L ATS Questionnaire (English)_El_Paso.doc
Yes
Yes
Printable Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
4,250
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
66 %
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
4,250
0
0
0
0
4,250
Annual IC Time Burden (Hours)
1,833
0
0
0
0
1,833
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Tracked change instrument
H-L ATS Questionnaire tracked changes.doc
07/13/2007
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.