OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Experimental Survey

IC 202182 under ICR 201301-0910-004 · OMB 0910-0736.

Documents and Forms
Document Name
Document Type
Other-Survey
Other-prototype
Other-prototype
Other-prototype
Other-prototype
Other-prototype
Other-prototype
Other-prototype
Other-prototype
Other-prototype
Other-prototype
Information Collection (IC) Details

View Information Collection (IC)

Experimental Survey
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Survey HPHC_Survey_Questions.pdf Yes Yes Fillable Fileable
Other-prototype HPHC_Prototype1Cigarette22.pdf Yes Yes Printable Only
Other-prototype HPHC_Prototype1RollYourOwn10.pdf Yes Yes Printable Only
Other-prototype HPHC_Prototype2RollYourOwn02.pdf Yes Yes Printable Only
Other-prototype HPHC_Prototype3Cigarette22.pdf Yes Yes Printable Only
Other-prototype HPHC_Prototype3RollYourOwn02.pdf Yes Yes Printable Only
Other-prototype HPHC_Prototype4CigaretteNoGraphs05.pdf Yes Yes Printable Only
Other-prototype HPHC_Prototype4RollYourOwn10.pdf Yes Yes Printable Only
Other-prototype HPHC_Prototype5RollYourOwn02.pdf Yes Yes Printable Only
Other-prototype HPHC_Prototype6Cigarette2.pdf Yes Yes Printable Only
Other-prototype HPHC_Prototype6RollYourOwn02.pdf Yes Yes Printable Only

Health Public Health Monitoring

 

3,150 0
   
Individuals or Households
 
   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 3,150 0 3,150 0 0 0
Annual IC Time Burden (Hours) 1,575 0 1,575 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
No associated records found
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.