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

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Form 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

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:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	2	Follow-Up Survey_Portuguese	#11_CRIM_Attach11C_Follow-up Screenshots_Portuguese.doc	Yes	Yes	Fillable Fileable
Form and Instruction	1	Follow-Up Survey_English	#11_Attach11B_Follow-up Survey_English.docx	Yes	Yes	Fillable Fileable
Form and Instruction	3	Follow-Up Survey_Spanish	#11_CRIM_Attach11D_Follow-up Screenshots_Spanish.docx	Yes	Yes	Fillable Fileable
Form and Instruction	4	#12 Smokefree.gov Screenshots Part 1	#12_Attach 1A_TCRB Screenshot_5-8-2012.jpg	Yes	Yes	Fillable Fileable
Form and Instruction	5	#12 Smokefree.gov Screenshots Part 2	#12_Attach 1B_TCRB Screenshot_5-8-2012.jpg	Yes	Yes	Fillable Fileable

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 %

	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

Title	Document	Date Uploaded
Fast-Track Request #11_Follow-up Multi-Lang Survey	Fast-Track Request #11_Follow-up Multi-Lang Survey.doc	04/18/2012
#11_Attach11A_Invite Email	#11_Attach11A_Invite Email.docx	04/18/2012
Fast-Track Request #12_Smokefree.gov User Survey	#12_TCRB_Fast Track Request.doc	05/14/2012
Memo to OMB re: Bundle	Bundle Memo for OMB.docx	05/14/2012

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