Evaluation of the National Tobacco Prevention and Control Public Education Campaign

Forms and Documents

Document Name	Status
Form 0920-0923 Non-Smoker Follow-up Questionnaire Form	Modified
Non-Smoker Baseline Questionnaire Form	Modified
Form 0920-xxxx Smoker Follow-up Questionnaire Form	Modified
Smoker Baseline Questionnaire Form	Modified
Screening and Consent Form	Modified
0920-0923 Change Request Justification.docx Justification for No Material/Nonsubstantive Change	2012-04-23
Tips Banner Ads (Compiled).JPG Supplementary Document	2012-04-23
Tips Out-of-Home Compiled.JPG Supplementary Document	2012-04-23
Tips Print Ads (Compiled).JPG Supplementary Document	2012-04-23
Att E-2 Email Notification and Reminders_1-6-12 (REVISED 2-7-12).doc Supplementary Document	2012-02-17

IC Document Collections

IC ID	Document Title	Status
200741	Non-Smoker Follow-up Questionnaire Form	Modified
200740	Non-Smoker Baseline Questionnaire Form	Modified
200739	Smoker Follow-up Questionnaire Form	Modified
200738	Smoker Baseline Questionnaire Form	Modified
200737	Screening and Consent Form	Modified

ICR Details

OMB Control No: 0920-0923	ICR Reference No: 201204-0920-006
Status: Historical Active	Previous ICR Reference No: 201201-0920-004
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Evaluation of the National Tobacco Prevention and Control Public Education Campaign
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/27/2012
	Date Received in OIRA: 04/27/2012
Terms of Clearance: Previous terms continue: All communications about the evaluation results via these uses of the information, including any and all Congressional testimony, will carefully enumerate and describe any underlying limitations of the data and ensure that evaluation results are interpreted with appropriate care and caution. CDC acknowledges that study design limitations decrease their capacity to draw nationally representative conclusions about either smoking-related knowledge and behavior or the impact of the campaign on long-term quit rates in sub-populations.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2013	02/28/2013	02/28/2013
Responses	55,926	0	55,926
Time Burden (Hours)	10,015	0	10,015
Cost Burden (Dollars)	0	0	0

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Abstract: This is a request for approval of 4 new questions on the follow-up smoker and nonsmoker surveys, to assess specific online, print, and out-of-home comapaign adverstisements.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 4004 Name of Law: Patient Protection and Affordable Care Act
   PL: Pub.L. 111 - 31 203 Name of Law: Family Smoking Prevention and Tobacco Control Act
   US Code: 42 USC 301 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

Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 5

IC Title	Form No.	Form Name
Screening and Consent	none	Screen and Consent
Smoker Baseline Questionnaire	none	Smoker Baseline
Smoker Follow-up Questionnaire	0920-xxxx	Smoker Followup
Non-Smoker Baseline Questionnaire	none	NonSmoker Baseline
Non-Smoker Follow-up Questionnaire	0920-0923	Nonsmoker Follow-up

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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	55,926	55,926	0	0	0	0
Annual Time Burden (Hours)	10,015	10,015	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $742,557

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? No

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

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

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: 04/27/2012

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