Information Collection

Sub-studies #11 & #12 - Web-based Surveys of Cancer Research in Media 2010 Workshop (#11) & Smokefree.gov Users (#12)

IC 202292 under ICR 201108-0925-002 · OMB 0925-0642.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0642 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2 Follow-Up Survey_Portuguese Sub-studies #11 & #12 - Web-based Surveys of Cancer Research in Media 2010 Workshop (#11) & Smokefree.gov Users (#12)	Form and Instruction
Form 1 Follow-Up Survey_English Sub-studies #11 & #12 - Web-based Surveys of Cancer Research in Media 2010 Workshop (#11) & Smokefree.gov Users (#12)	Form and Instruction
Form 3 Follow-Up Survey_Spanish Sub-studies #11 & #12 - Web-based Surveys of Cancer Research in Media 2010 Workshop (#11) & Smokefree.gov Users (#12)	Form and Instruction
Form 4 #12 Smokefree.gov Screenshots Part 1 Sub-studies #11 & #12 - Web-based Surveys of Cancer Research in Media 2010 Workshop (#11) & Smokefree.gov Users (#12)	Form and Instruction
Form 5 #12 Smokefree.gov Screenshots Part 2 Sub-studies #11 & #12 - Web-based Surveys of Cancer Research in Media 2010 Workshop (#11) & Smokefree.gov Users (#12)	Form and Instruction
1 Follow-Up Survey_English #11_Attach11B_Follow-up Survey_English.docx	Form and Instruction
2 Follow-Up Survey_Portuguese #11_CRIM_Attach11C_Follow-up Screenshots_Portuguese.doc	Form and Instruction
3 Follow-Up Survey_Spanish #11_CRIM_Attach11D_Follow-up Screenshots_Spanish.docx	Form and Instruction
4 #12 Smokefree.gov Screenshots Part 1 #12_Attach 1A_TCRB Screenshot_5-8-2012.jpg	Form and Instruction
5 #12 Smokefree.gov Screenshots Part 2 #12_Attach 1B_TCRB Screenshot_5-8-2012.jpg	Form and Instruction
Fast-Track Request #11_Follow-up Multi-Lang Survey.doc Fast-Track Request #11_Follow-up Multi-Lang Survey	IC Document
#11_Attach11A_Invite Email.docx #11_Attach11A_Invite Email	IC Document
#12_TCRB_Fast Track Request.doc Fast-Track Request #12_Smokefree.gov User Survey	IC Document
Bundle Memo for OMB.docx Memo to OMB re: Bundle	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Sub-studies #11 & #12 - Web-based Surveys of Cancer Research in Media 2010 Workshop (#11) & Smokefree.gov Users (#12)

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Yes	Yes	Fillable Fileable
Form and Instruction	2	Yes	Yes	Fillable Fileable
Form and Instruction	3	Yes	Yes	Fillable Fileable
Form and Instruction	4	Yes	Yes	Fillable Fileable
Form and Instruction	5	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,025

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	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	3,025	0	0	0	0	0
Annual IC Time Burden (Hours)	256	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Fast-Track Request #11_Follow-up Multi-Lang Survey		04/18/2012
#11_Attach11A_Invite Email		04/18/2012
Fast-Track Request #12_Smokefree.gov User Survey		05/14/2012
Memo to OMB re: Bundle		05/14/2012

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

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