National Adult Tobacco Survey Questionnaire

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⚠️ Notice: This information collection may be referencing outdated material.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 Questionnaire Form and Instruction
National Adult Tobacco Survey questionnaire - English Appendix_F_(English_language)_New29B_11.03.09.doc Form and Instruction
National Adult Tobacco Survey - Spanish Appendix_G_(Spanish_Language)_New29B_11.03.09.doc Form and Instruction

Information Collection (IC) Details

IC Title:	National Adult Tobacco Survey Questionnaire	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	none	National Adult Tobacco Survey questionnaire - English	Appendix_F_(English_language)_New29B_11.03.09.doc		Yes	No	Printable Only
Form and Instruction	none	National Adult Tobacco Survey - Spanish	Appendix_G_(Spanish_Language)_New29B_11.03.09.doc		Yes	No	Printable Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 98,013	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	98,013	98,013
Annual IC Time Burden (Hours)	32,671	32,671
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.