Information Collection

Non-Smoker Follow-up Questionnaire

IC 200741 under ICR 201204-0920-006 · OMB 0920-0923.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0923 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0923 Non-Smoker Follow-up Questionnaire	Form
0920-0923 Nonsmoker Follow-up Att D-2 Nonsmoker Follow-up Survey_4-17-12.docx	Form
Tips Out-of-Home Compiled.JPG Tips Out-of-Home Compiled	IC Document
Tips Banner Ads (Compiled).JPG Tips Banner Ads (Compiled)	IC Document

IC Title:

Non-Smoker Follow-up Questionnaire

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	0920-0923	Nonsmoker Follow-up	Att D-2 Nonsmoker Follow-up Survey_4-17-12.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,000

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	Previously Approved
Annual Number of Responses for this IC	2,000	2,000
Annual IC Time Burden (Hours)	833	833
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Tips Out-of-Home Compiled	Tips Out-of-Home Compiled.JPG	04/23/2012
Tips Banner Ads (Compiled)	Tips Banner Ads (Compiled).JPG	04/23/2012

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