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Smoking diary
Human Smoking Behavior Study
OMB: 0920-0736
IC ID: 194763
OMB.report
HHS/CDC
OMB 0920-0736
ICR 201009-0920-006
IC 194763
( )
Documents and Forms
Document Name
Document Type
Form No number
Smoking diary
Form
No number Smoking diary
Attachment H. Smoking Diary.pdf
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Smoking diary
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
No number
Smoking diary
Attachment H. Smoking Diary.pdf
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Illness Prevention
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
61
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
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
61
0
61
0
0
0
Annual IC Time Burden (Hours)
10
0
10
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
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.
