Experimental Survey

Experimental Study on the Public Display of Lists of Harmful and Potential Harmful Tobacco Constituents

Documents and Forms

Document Name Document Type
HPHC_Survey_Questions.pdf Other-Survey
HPHC_Prototype1Cigarette22.pdf Other-prototype
HPHC_Prototype1RollYourOwn10.pdf Other-prototype
HPHC_Prototype2RollYourOwn02.pdf Other-prototype
HPHC_Prototype3Cigarette22.pdf Other-prototype
HPHC_Prototype3RollYourOwn02.pdf Other-prototype
HPHC_Prototype4CigaretteNoGraphs05.pdf Other-prototype
HPHC_Prototype4RollYourOwn10.pdf Other-prototype
HPHC_Prototype5RollYourOwn02.pdf Other-prototype
HPHC_Prototype6Cigarette2.pdf Other-prototype
HPHC_Prototype6RollYourOwn02.pdf Other-prototype

Information Collection (IC) Details

IC Title:	Experimental Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	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

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,150	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,150	3,150
Annual IC Time Burden (Hours)	1,575	1,575
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.