Information Collection

National Adult Tobacco Survey Questionnaire

IC 190595 under ICR 200807-0920-007 · OMB 0920-0798.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0798 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
National Adult Tobacco Survey Questionnaire - English.doc	Other-Telephone Survey
NATS Pre-Test Request 07 23 09.doc Supporting Statement	IC Document

IC Title:

National Adult Tobacco Survey Questionnaire

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Telephone Survey			National Adult Tobacco Survey Questionnaire - English.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 963

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	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	963	0	0	0	0	0
Annual IC Time Burden (Hours)	137	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement	NATS Pre-Test Request 07 23 09.doc	09/10/2009

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