Smoker Survery - Wave I

Extended Evaluation of the National Tobacco Prevention and Control Public Education Campaign

Documents and Forms

Document Name Document Type
Form 0920-1083 Smoker Survery - Wave I Form and Instruction
0920-1083 Smoker Survey - Wave I Attachment D-1. Smoker Survey Screenshots_9-28-22.pdf Form and Instruction
0920-1083 Smoker Survey - Wave I Attachment D-1. Smoker Survey Screenshots_9-28-22.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Smoker Survery - Wave I	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	0920-1083	Smoker Survey - Wave I	Attachment D-1. Smoker Survey Screenshots_9-28-22.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,667	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	1,667	1,667
Annual IC Time Burden (Hours)	556	556
Annual IC Cost Burden (Dollars)	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.