0920-0923 Change Request_5 29 2013

Change Request

OMB No. 0920-0923

Revision ICR Reference No: 201302-0920-014

Evaluation of the National Tobacco Prevention and Control Public Education Campaign

May 29, 2013

On 2/17/2012, OMB approved a New ICR to support Phase 1 baseline and follow-up data collection in 2012 (Wave 1 data collection and Wave 2 data collection). Different questionnaires were developed for smokers and non-smokers.

On 4/10/2013, OMB approved a Revision ICR to support Phase 2 follow-up in 2013 (Wave 3 data collection for smokers and non-smokers). The complete content of each follow-up questionnaire was presented in a .DOC file, and sample screen shots were presented as .PDF files. The Attachments were identified in the Revision ICR as follows:

C-2a. Smoker Phase 2 Follow-Up Questionnaire (.DOC version)

C-2b. Sample Screen Shots of the Smoker Phase 2 Follow-Up Questionnaire (.PDF version)

D-2a. Non-Smoker Phase 2 Follow-Up Questionnaire (.DOC version)

D-2b. Sample Screen Shots of the Non-Smoker Phase 2 Follow-Up Questionnaire (.PDF version)

A key file was omitted from the upload to the OMB Web site. CDC requests the following:

1. IC = “2013 Smoker Follow-up Questionnaire (Phase 2)”

• Upload file <<Att C-2a Smoker wave 3 survey 1 8 13.doc>>. This is the data collection instrument for this IC.

• The file <<Att I-b. 2012 SmokerFollow-upSurvey(C-2)>> is not the instrument associated with this IC. It can be deleted or moved to the associated “supplementary documents” as a reference document.

• Federal Enterprise Architecture Business Reference Module: Change from <<Immunization Management>> to << Population Health Management and Consumer Safety>>

2. IC= “2013 Non-Smoker Follow-up questionnaire (Phase 2)”

• Federal Enterprise Architecture Business Reference Module: Change from <<Immunization Management>> to << Population Health Management and Consumer Safety>>

• No other changes are requested for this IC