PATH/Baseline- Adults Household Screener

Population Assessment of Tobacco and Health (PATH) Study (NIDA)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0664 can be found here:

Documents and Forms

Document Name Document Type
Form 1 PATH/Baseline- Adults Household Screener Form and Instruction
1 Household Screener 3a - English. PATH Wave 1 Household Screener 7.5 2013-06-10.pdf Form and Instruction
3a. Spanish. PATH Wave 1 Household Screener 7.5 2013-06-10.pdf 3a IC Document

Information Collection (IC) Details

IC Title:	PATH/Baseline- Adults Household Screener	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 and Instruction	1	Household Screener	3a - English. PATH Wave 1 Household Screener 7.5 2013-06-10.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title: NIH Privacy Act System of Records 09-25-0200 Clinical, Basic Population-based research studies of NIH, HHS/NIH/OD	FR Citation: 67 FR 60741

Number of Respondents: 104,725	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	104,725	104,725
Annual IC Time Burden (Hours)	24,436	24,436
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
3a	3a. Spanish. PATH Wave 1 Household Screener 7.5 2013-06-10.pdf	06/28/2013

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