National Adult Tobacco Survey

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
National Adult Tobacco Survey Screener - Spanish	Form and Instruction	Modified	Available
National Adult Tobacco Survey Screener - English	Form and Instruction	Modified	Available
National Adult Tobacco Survey - Spanish	Form and Instruction	Modified	Available
National Adult Tobacco Survey questionnaire - English	Form and Instruction	Modified	Available
Part_B_NATS_10_06_09.doc	Supporting Statement B	Uploaded 2009-11-05	Available
NATS_Change_Justification_11.03.09.doc	Justification for No Material/Nonsubstantive Change	Uploaded 2009-11-05	Available
Part_A_NATS_10_06_09.doc	Supporting Statement A	Uploaded 2009-11-05	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
190631	National Adult Tobacco Survey Screener	Form and Instruction	Modified	National Adult Tobacco Survey Screener - Spanish
190631	National Adult Tobacco Survey Screener	Form and Instruction	Modified	National Adult Tobacco Survey Screener - English
190630	National Adult Tobacco Survey Questionnaire	Form and Instruction	Modified	National Adult Tobacco Survey - Spanish
190630	National Adult Tobacco Survey Questionnaire	Form and Instruction	Modified	National Adult Tobacco Survey questionnaire - English

ICR Details

OMB Control No: 0920-0828	ICR Reference No: 200911-0920-007
Status: Historical Active	Previous ICR Reference No: 200909-0920-003
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: National Adult Tobacco Survey
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/25/2009
Retrieve Notice of Action (NOA)	Date Received in OIRA: 11/24/2009
Terms of Clearance:

table that charts list comparision

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

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Abstract: CDC would like to add one additional question seeking information on cigarette purchase patterns to the survey.

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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	none, none	National Adult Tobacco Survey questionnaire - English ,   National Adult Tobacco Survey - Spanish
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	269,686	0	0	0	0
Annual Time Burden (Hours)	38,303	38,303	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement:

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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: 11/24/2009

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