National Adult Tobacco Survey Screener - Landline

National Adult Tobacco Survey

Documents and Forms

Document Name Document Type
I-1 Landline Screener.docx Instruction
H-1 Landline Screener.docx Instruction

Information Collection (IC) Details

IC Title:	National Adult Tobacco Survey Screener - Landline	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
Instruction			I-1 Landline Screener.docx		Yes	Yes	Printable Only
Instruction			H-1 Landline Screener.docx		Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 125,000	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	125,000	125,000
Annual IC Time Burden (Hours)	4,167	4,167
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.