2013 Smoker Follow-up Questionnaire (Phase 2)

Evaluation of the National Tobacco Prevention and Control Public Education Campaign

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
2013 Smoker Follow-up Questionnaire (Phase 2) Form
CDC National Media Campaign--Revised Smoker Questionnair Att C-2a. Revised Smoker wave 3 survey 6-11-13.docx Form
Att C-2b. Smoker Survey_Screenshots Rev Dec28 v2.pdf Att C-2b. Smoker Survey_Screenshots Rev Dec28 v2 IC Document
Att I-a. 2012 Smoker_Baseline_Questionnaire (C-1).docx Att I-a. 2012 Smoker_Baseline_Questionnaire (C-1) IC Document

Information Collection (IC) Details

IC Title:	2013 Smoker Follow-up Questionnaire (Phase 2)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	None	CDC National Media Campaign--Revised Smoker Questionnaire	Att C-2a. Revised Smoker wave 3 survey 6-11-13.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 14,250	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	14,250	14,250
Annual IC Time Burden (Hours)	5,938	5,938
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Att C-2b. Smoker Survey_Screenshots Rev Dec28 v2	Att C-2b. Smoker Survey_Screenshots Rev Dec28 v2.pdf	02/07/2013
Att I-a. 2012 Smoker_Baseline_Questionnaire (C-1)	Att I-a. 2012 Smoker_Baseline_Questionnaire (C-1).docx	02/13/2013

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