National Adult Tobacco Survey

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
National Adult Tobacco Survey Screener	Form and Instruction	New	Available
National Adult Tobacco Survey Questionnaire	Form and Instruction	New	Available
Appendix K - NATS Advance Letter.doc	Supplementary Document	Uploaded 2009-10-15	Available
Part B_NATS_10_06_09.doc	Supporting Statement B	Uploaded 2009-10-15	Available
Appendix J - Sample Table Shells.docx	Supplementary Document	Uploaded 2009-08-25	Available
Appendix I - Confidentiality Agreement Signed by Interviewers.doc	Supplementary Document	Uploaded 2009-08-25	Available
Appendix H - IRB Approval.pdf	Supplementary Document	Uploaded 2009-08-25	Available
Appendix E. Consultants.doc	Supplementary Document	Uploaded 2009-10-19	Repair queued
Appendix C - 60-Day FRN Comments.docx	Supplementary Document	Uploaded 2009-08-25	Repair queued
Appendix D - Item-level justification NATS.docx	Supplementary Document	Uploaded 2009-08-25	Available
Appendix B - Federal Register Notice.pdf	Supplementary Document	Uploaded 2009-08-25	Available
Appendix A - Authorizing Legislation.doc	Supplementary Document	Uploaded 2009-08-25	Available
Part A_NATS_10_06_09.doc	Supporting Statement A	Uploaded 2009-10-15	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
190631	National Adult Tobacco Survey Screener	Form and Instruction	New
190630	National Adult Tobacco Survey Questionnaire	Form and Instruction	New

ICR Details

OMB Control No: 0920-0828	ICR Reference No: 200909-0920-003
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: National Adult Tobacco Survey
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 10/19/2009
	Date Received in OIRA: 09/11/2009
Terms of Clearance: Approved consistent with revised instruments and supplemental documents uploaded on 10/15/09 and 10/19/09.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2010	12 Months From Approved
Responses	269,686	0	0
Time Burden (Hours)	38,303	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: CDC proposes to conduct the National Adult Tobacco Survey (NATS) in 2009-2010 to help improve and evaluate the effectiveness of the National Tobacco Control Program (NTCP). The NATS will be a one-time, stratified, random-digit dialed telephone survey of non-institutionalized adults 18 years of age and older.

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Authorizing Statute(s): US Code: 42 USC 241 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
60-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 27144	06/08/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 45214	09/01/2009
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
National Adult Tobacco Survey Questionnaire	No number, NA, N/A, N/A	Appendix F (English language) ,   Appendix G (Spanish Language)
National Adult Tobacco Survey Screener	NA, NA	National Adult Tobacco Survey Screener - English ,   National Adult Tobacco Survey Screener - Spanish

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ICR Summary of Burden

table that charts list 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	269,686	0	0	269,686	0	0
Annual Time Burden (Hours)	38,303	0	0	38,303	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: This is a new data collection request.

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Annual Cost to Federal Government: $1,997,743

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]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

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: 09/11/2009

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