Information Collection

Questionnaire Design Research Laboratory - Testing Smoking Cessation and Oral Health Questions

IC 190015 under ICR 200902-0920-005 · OMB 0920-0222.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0222 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Questionnaire Design Research Laboratory - Testing Smoking Cessation and Oral Health Questions	Form
QDRL - Testing Smoking Cessation Products and Services QDRL OMB-10-day letter-SmokingDentalHealth att.2 quest. 0709.doc	Form
QDRL OMB-10-day letter-SmokingDentalHealth 0709.doc 10 day letter to Margo Schwab - justification for request	IC Document
QDRL OMB-10-day letter-SmokingDentalHealth att.1 0709.doc Attachment 1 - Advertisement for participants	IC Document

IC Title:

Questionnaire Design Research Laboratory - Testing Smoking Cessation and Oral Health Questions

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
Form	none	QDRL - Testing Smoking Cessation Products and Services	QDRL OMB-10-day letter-SmokingDentalHealth att.2 quest. 0709.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 25

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

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	25	0	0	0	0	0
Annual IC Time Burden (Hours)	25	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
10 day letter to Margo Schwab - justification for request	QDRL OMB-10-day letter-SmokingDentalHealth 0709.doc	07/13/2009
Attachment 1 - Advertisement for participants	QDRL OMB-10-day letter-SmokingDentalHealth att.1 0709.doc	07/13/2009

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