OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Individuals

IC 211374 under ICR 201404-0925-002 · OMB 0925-0368.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form
Form and Instruction
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Individuals
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 1-Rev Revised 2014-2015 TUS-CPS Form A1_TUS-CPS Questionnaire_2014-15 (3).docx Yes Yes Fillable Fileable
Form 1 Main 2014-2015 Tobacco Use Supplement Questionnaire A1_TUS-CPS Questionnaire_2014-15_4-3-14.doc Yes Yes Fillable Fileable

Health Health Care Services

 

127,500 0
   
Individuals or Households
 
   15 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 127,500 0 127,500 0 0 0
Annual IC Time Burden (Hours) 12,750 0 12,750 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
2014-2015 DRAFT Spanish Version TUS-CPS A14_TUS-CPS Qx Spanish DRAFT_2014-2015.docx 04/28/2014
2014-2015 REVISED Spanish TUS_CPS Version Final 2014 Spanish Short Form 24Jun2014 (3).docx 06/24/2014
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.