Modification to El Paso Tx Survey instrument

2006 Hispanic/Latino Adult Tobacco Survey

Documents and Forms

Document Name Document Type
H-L ATS Questionnaire (All Spanish)_El_Paso.doc Instruction
H-L ATS Questionnaire (English)_El_Paso.doc Instruction
H-L ATS Questionnaire tracked changes.doc Instrument with tracked changes IC Document

Information Collection (IC) Details

IC Title:	Modification to El Paso Tx Survey instrument	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	No	Printable Only
Instruction			H-L ATS Questionnaire (English)_El_Paso.doc		Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 750	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 66 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	750	750
Annual IC Time Burden (Hours)	400	400
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Instrument with tracked changes	H-L ATS Questionnaire tracked changes.doc	07/19/2007

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.