National Adult Tobacco Survey Screener

National Adult Tobacco Survey

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0828 can be found here:

Documents and Forms

Document Name Document Type
National Adult Tobacco Survey Screener Form and Instruction
National Adult Tobacco Survey Screener - English Appendix F - National Adult Tobacco Survey Questionnaire - English.doc Form and Instruction
National Adult Tobacco Survey Screener - Spanish Appendix G -National Adult Tobacco Survey Questionnaire - Spanish.doc Form and Instruction

Information Collection (IC) Details

IC Title:	National Adult Tobacco Survey Screener	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
Form and Instruction	NA	National Adult Tobacco Survey Screener - English	Appendix F - National Adult Tobacco Survey Questionnaire - English.doc		Yes	No	Fillable Printable
Form and Instruction	NA	National Adult Tobacco Survey Screener - Spanish	Appendix G -National Adult Tobacco Survey Questionnaire - Spanish.doc		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 171,673	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	171,673	171,673
Annual IC Time Burden (Hours)	5,632	5,632
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.