Evaluation of the National Tobacco Prevention and Control Public Education Campaign

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Non-smoker Followup	Form	New	Available
NonSmoker Baseline	Form	New	Available
Smoker Followup	Form	New	Available
Smoker Baseline Questionnaire	Form	New	Repair queued
Screen and Consent	Form	New	Available
Att I-1 Primary Secondary Outcomes and Survey Items.doc	Supplementary Document	Uploaded 2012-02-17	Available
SS Part B_1-6-12 (REVISED 2-16-12)_(Alternate) Clean (1).docx	Supporting Statement B	Uploaded 2012-02-17	Available
Att F-1. KN Recruitment Procedures.DOC	Supplementary Document	Uploaded 2012-01-05	Available
Att H-2. Yeager et al POQ 2011.pdf	Supplementary Document	Uploaded 2012-01-05	Available
Att H-1. Chang & Krosnick Internet Surveys POQ 2009.pdf	Supplementary Document	Uploaded 2012-01-05	Available
Att G. RTI IRB Approval Notice 12-06-11.pdf	Supplementary Document	Uploaded 2012-01-05	Available
Att F-2. KN Privacy and Security Procedures.doc	Supplementary Document	Uploaded 2012-01-05	Available
Att B-2. Summary of Public Comments.doc	Supplementary Document	Uploaded 2012-01-05	Available
Att B-1. Federal Register Notice.pdf	Supplementary Document	Uploaded 2012-01-05	Available
Att A-3. Public Law 111-148 Section 4004.pdf	Supplementary Document	Uploaded 2012-01-05	Available
Att A-2. Public Law 111-31 FSPTCA.PDF	Supplementary Document	Uploaded 2012-01-05	Available
Att A-1. Public Health Service Act.doc	Supplementary Document	Uploaded 2012-01-05	Available
Att E-2 Email Notification and Reminders_1-6-12 (REVISED 2-7-12).doc	Supplementary Document	Uploaded 2012-02-17	Available
SS Part A_1-6-12 (REVISED 2-16-12)_(Alternate) Clean (1).docx	Supporting Statement A	Uploaded 2012-02-17	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
200741	Non-Smoker Follow-up Questionnaire	Form	New	Non-smoker Followup
200740	Non-Smoker Baseline Questionnaire	Form	New	NonSmoker Baseline
200739	Smoker Follow-up Questionnaire	Form	New	Smoker Followup
200738	Smoker Baseline Questionnaire	Form	New	Smoker Baseline Questionnaire
200737	Screening and Consent	Form	New	Screen and Consent

ICR Details

OMB Control No: 0920-0923	ICR Reference No: 201201-0920-004
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Evaluation of the National Tobacco Prevention and Control Public Education Campaign
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 02/17/2012
Retrieve Notice of Action (NOA)	Date Received in OIRA: 01/11/2012
Terms of Clearance: Approved consistent with the following terms: All communications about the evaluation results via these uses of the information, including any and all Congressional testimony, will carefully enumerate and describe any underlying limitations of the data and ensure that evaluation results are interpreted with appropriate care and caution. CDC acknowledges that study design limitations decrease their capacity to draw nationally representative conclusions about either smoking-related knowledge and behavior or the impact of the campaign on long-term quit rates in sub-populations.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2013	12 Months From Approved
Responses	55,926	0	0
Time Burden (Hours)	10,015	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: CDC's Office on Smoking and Health (OSH) requests OMB approval of baseline and follow-up data collection to assess awareness of and exposure to tobacco education campaign advertisements that will be launched early in 2012. In addition, information will be collected about smokers' and non-smokers' knowledge, attitudes and beliefs related to smoking.

---

Authorizing Statute(s): PL: Pub.L. 111 - 148 4004 Name of Law: Patient Protection and Affordable Care Act
   PL: Pub.L. 111 - 31 203 Name of Law: Family Smoking Prevention and Tobacco Control Act
   US Code: 42 USC 301 Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 40914	07/12/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 508	01/05/2012
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 5

table that charts list of burden

IC Title	Form No.	Form Name
Non-Smoker Baseline Questionnaire	none	NonSmoker Baseline
Non-Smoker Follow-up Questionnaire	none	Non-smoker Followup
Screening and Consent	none	Screen and Consent
Smoker Baseline Questionnaire	none	Smoker Baseline Questionnaire
Smoker Follow-up Questionnaire	none	Smoker Followup

---

ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	55,926	0	0	55,926	0	0
Annual Time Burden (Hours)	10,015	0	0	10,015	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new data collection.

---

Annual Cost to Federal Government: $742,557

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Yes

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 01/11/2012

---