Non-smoker Follow-up Survey Wave 4

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⚠️ Notice: This information collection may be referencing outdated material.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
Non-smoker Follow-up Survey Wave 4 Form
Non-smoker Follow-up Survey Wave 4 - screenshots Attachment C-5 (Screenshots) 2-6-14.pdf Form
Non-smoker Follow-up Survey Wave 4 - Spanish screenshots Attachment C-5 (Screenshots Spanish) 2-6-14.pdf Form
Attachment C-5 Nonsmoker Follow-Up Survey (Waves 2-5) 2-6-14.docx Non-smoker Follow-up Survey Wave 4 - Word IC Document
Attachment C-5 (Spanish) 2-6-14.docx Non-smoker Follow-up Survey Wave 4 - Spanish IC Document

Information Collection (IC) Details

IC Title:	Non-smoker Follow-up Survey Wave 4	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	Non-smoker Follow-up Survey Wave 4 - screenshots	Attachment C-5 (Screenshots) 2-6-14.pdf		Yes	Yes	Fillable Fileable
Form	none	Non-smoker Follow-up Survey Wave 4 - Spanish screenshots	Attachment C-5 (Screenshots Spanish) 2-6-14.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 442	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	442	442
Annual IC Time Burden (Hours)	221	221
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Non-smoker Follow-up Survey Wave 4 - Word	Attachment C-5 Nonsmoker Follow-Up Survey (Waves 2-5) 2-6-14.docx	02/10/2014
Non-smoker Follow-up Survey Wave 4 - Spanish	Attachment C-5 (Spanish) 2-6-14.docx	02/10/2014

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