Individuals

Next Series of Tobacco Use Supplements to the Current Population Survey (TUS-CPS) (NCI)

Documents and Forms

Document Name Document Type
Form 1-Rev Individuals Form and Instruction
1 Main 2014-2015 Tobacco Use Supplement Questionnaire A1_TUS-CPS Questionnaire_2014-15_4-3-14.doc Form
1-Rev Revised 2014-2015 TUS-CPS Form A1_TUS-CPS Questionnaire_2014-15 (3).docx Form and Instruction
A14_TUS-CPS Qx Spanish DRAFT_2014-2015.docx 2014-2015 DRAFT Spanish Version TUS-CPS IC Document
Final 2014 Spanish Short Form 24Jun2014 (3).docx 2014-2015 REVISED Spanish TUS_CPS Version IC Document

Information Collection (IC) Details

IC Title:	Individuals	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 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

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 127,500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 15 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	127,500	127,500
Annual IC Time Burden (Hours)	12,750	12,750
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.