Information Collection

BeTobaccoFree.gov Website Satisfaction Survey

IC 204031 under ICR 201106-0990-001 · OMB 0990-0379.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0379 can be found here:

Documents and Forms

Document Name Document Type
betobaccofreegov-vocquestions-v2.docx Other-Other
Generic Clearance Submission - Tobacco.docx Generic Clearance Submission - Tobacco IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	BeTobaccoFree.gov Website Satisfaction Survey	Agency IC Tracking Number:

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
Other-Other			betobaccofreegov-vocquestions-v2.docx		No	No	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 6,000	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	6,000	0	0	0	0	0
Annual IC Time Burden (Hours)	167	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Generic Clearance Submission - Tobacco	Generic Clearance Submission - Tobacco.docx	09/13/2012

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.