Information Collection Request

Evaluation of the National Tobacco Prevention and Control Public Education Campaign

ICR 201402-0920-011 · OMB 0920-0923 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Non-smoker Follow-up Survey Wave 4 Form New Available
Non-smoker Follow-up Survey Wave 3 Form New Available
Non-smoker Follow-up Survey Wave 2 Form New Available
Smoker Follow-up Survey Wave 5 Form New Repair queued
Smoker Follow-up Survey Wave 4 Form New Available
Smoker Follow-up Survey Wave 3 Form New Repair queued
Smoker Follow-up Survey Wave 2 Form New Available
Non-Smoker Survey Wave 1 Form Modified Available
Smoker Wave 1 Survey Form and Instruction Modified Available
Screening and Consent Form Modified Repair queued
SS Part B_01 31 2014.docx Supporting Statement B Uploaded 2014-02-10 Available
Attachment G-3 ABS Sample Post Card Reminders.docx Supplementary Document Uploaded 2014-02-10 Available
Attachment G-2 KnowledgePanel Email Invitation Reminders 1-15-14.doc Supplementary Document Uploaded 2014-02-10 Repair queued
Attachment G-1 ABS Sample Invitation Letter 2 6 2014.docx Supplementary Document Uploaded 2014-02-10 Available
Attachment F-1 GfK Privacy and Security Procedures.doc Supplementary Document Uploaded 2014-02-10 Available
Attachment E-1 RTI IRB Approval Notice.pdf Supplementary Document Uploaded 2014-02-10 Available
Attachment D-1 KnowledgePanel Recruitment Procedures.DOC Supplementary Document Uploaded 2014-02-10 Available
Attachment C-6 Summary of Key Construct Changes.docx Supplementary Document Uploaded 2014-02-10 Available
Attachment B-2 Summary of Public Comments.pdf Supplementary Document Uploaded 2014-02-10 Available
Attachment B-1 Federal Register Notice.pdf Supplementary Document Uploaded 2014-02-10 Available
Attachment A-3 PPHF.pdf Supplementary Document Uploaded 2014-02-10 Available
Attachment A-2 Familly Smoking Prevention & Tobacco Control Act.PDF Supplementary Document Uploaded 2014-02-10 Available
Attachment A-1 Public Health Service Act.doc Supplementary Document Uploaded 2014-02-10 Repair queued
Attachment C-5 (Spanish) 2-6-14.docx Supplementary Document Uploaded 2014-02-10 Available
Attachment C-5 Nonsmoker Follow-Up Survey (Waves 2-5) 2-6-14.docx Supplementary Document Uploaded 2014-02-10 Available
Attachment C-5 (Spanish) 2-6-14.docx Supplementary Document Uploaded 2014-02-10 Available
Attachment C-5 Nonsmoker Follow-Up Survey (Waves 2-5) 2-6-14.docx Supplementary Document Uploaded 2014-02-10 Available
Attachment C-5 (Spanish) 2-6-14.docx Supplementary Document Uploaded 2014-02-10 Available
Attachment C-5 Nonsmoker Follow-Up Survey (Waves 2-5) 2-6-14.docx Supplementary Document Uploaded 2014-02-10 Available
Attachment C-3 (Spanish) 2-6-14.docx Supplementary Document Uploaded 2014-02-10 Available
Attachment C-3 Smoker Follow-Up Survey (Waves 2-5)_2-6-14.docx Supplementary Document Uploaded 2014-02-10 Available
Attachment C-3 (Spanish) 2-6-14.docx Supplementary Document Uploaded 2014-02-10 Available
Attachment C-3 Smoker Follow-Up Survey (Waves 2-5)_2-6-14.docx Supplementary Document Uploaded 2014-02-10 Available
Attachment C-3 (Spanish) 2-6-14.docx Supplementary Document Uploaded 2014-02-10 Available
Attachment C-3 Smoker Follow-Up Survey (Waves 2-5)_2-6-14.docx Supplementary Document Uploaded 2014-02-10 Available
Attachment C-3 (Spanish) 2-6-14.docx Supplementary Document Uploaded 2014-02-10 Repair queued
Attachment C-3 Smoker Follow-Up Survey (Waves 2-5)_2-6-14.docx Supplementary Document Uploaded 2014-02-10 Repair queued
Attachment C-2 (Spanish) 2-6-14.docx Supplementary Document Uploaded 2014-02-10 Repair queued
Attachment C-2 Smoker Wave 1 Survey_2-6-14.docx Supplementary Document Uploaded 2014-02-10 Available
Attachment C-4 Nonsmoker Wave 1 Survey 2-6-14.docx Supplementary Document Uploaded 2014-02-10 Available
Attachment C-4 (Spanish) 2-6-14.docx Supplementary Document Uploaded 2014-02-10 Available
Attachment C-2 Smoker Wave 1 Survey_2-6-14.docx Supplementary Document Uploaded 2014-02-10 Available
Attachment C-2 (Spanish) 2-6-14.docx Supplementary Document Uploaded 2014-02-10 Available
Attachment C-1 Screening Questionnaire 2-6-14 (FINAL).docx Supplementary Document Uploaded 2014-02-10 Available
Attachment C-1 (Spanish) 2-6-14.doc Supplementary Document Uploaded 2014-02-10 Available
SS Part A_02 06 2014.docx Supporting Statement A Uploaded 2014-02-10 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
210363 Non-smoker Follow-up Survey Wave 4 Form New
210362 Non-smoker Follow-up Survey Wave 3 Form New
210361 Non-smoker Follow-up Survey Wave 2 Form New
210360 Smoker Follow-up Survey Wave 5 Form New
210359 Smoker Follow-up Survey Wave 4 Form New
210358 Smoker Follow-up Survey Wave 3 Form New
210357 Smoker Follow-up Survey Wave 2 Form New
200741 Non-Smoker Survey Wave 1 Form Modified
200739 Smoker Wave 1 Survey Form and Instruction Modified
200737 Screening and Consent Form Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
03/31/2017 36 Months From Approved 04/30/2014
28,447 0 61,273
8,777 0 8,765
0 0 0





Reginfo record details
10
table that charts list of burden
IC Title Form No. Form Name
Screening and Consent none, none Screening Questionnaire - Spanish Screenshots ,   Screening Questionnaire - screenshots
Smoker Wave 1 Survey none, none Smoker Wave 1 Questionnaire - screenshots ,   Smoker Wave 1 Questionnaire - Spanish screenshots
Non-Smoker Survey Wave 1 none, none Non-smoker Survey Wave 1 - Spanish screenshots ,   Non-smoker Survey Wave 1 screenshots
Smoker Follow-up Survey Wave 2 none, none Smoker Follow-up Survey Wave 2 - screenshots ,   Smoker Follow-up Survey Wave 2 - Spanish screenshots
Smoker Follow-up Survey Wave 3 none, none Smoker Follow-up Survey Wave 3 - Screenshots ,   Smoker Follow-up Survey Wave 3 - Spanish screenshots
Smoker Follow-up Survey Wave 4 none, none Smoker Follow-up Survey Wave 4 - Screenshots ,   Smoker Follow-up Survey Wave 4 - Spanish screenshots
Smoker Follow-up Survey Wave 5 none, none Smoker Follow-up Survey Wave 5 - Screenshots ,   Smoker Follow-up Survey Wave 5 - Spanish screenshots
Non-smoker Follow-up Survey Wave 2 none, none Non-smoker Survey Wave 2 - screenshots ,   Non-smoker Survey Wave 2 - Spanish screenshots
Non-smoker Follow-up Survey Wave 3 none, none Non-smoker Survey Wave 3 - screenshots ,   Non-smoker Follow-up Survey Wave 3 - Spanish screenshots
Non-smoker Follow-up Survey Wave 4 none, none Non-smoker Follow-up Survey Wave 4 - screenshots ,   Non-smoker Follow-up Survey Wave 4 - Spanish screenshots

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 28,447 61,273 0 -32,826 0 0
Annual Time Burden (Hours) 8,777 8,765 0 12 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No