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Non-smoker Follow-up Survey Wave 2
Evaluation of the National Tobacco Prevention and Control Public Education Campaign
OMB: 0920-0923
IC ID: 210361
OMB.report
HHS/CDC
OMB 0920-0923
ICR 201408-0920-002
IC 210361
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0923 can be found here:
2014-11-24 - No material or nonsubstantive change to a currently approved collection
2014-09-05 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
Non-smoker Follow-up Survey Wave 2
Form
Non-smoker Survey Wave 2 - screenshots
Attachment C-5 (Screenshots) 2-6-14.pdf
Form
Non-smoker Survey Wave 2 - 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 Survey Wave 2 - Word
IC Document
Attachment C-5 (Spanish) 2-6-14.docx
Non-smoker Survey Wave 2 - Spanish
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Non-smoker Follow-up Survey Wave 2
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Unchanged
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 Survey Wave 2 - screenshots
Attachment C-5 (Screenshots) 2-6-14.pdf
Yes
Yes
Fillable Fileable
Form
none
Non-smoker Survey Wave 2 - Spanish screenshots
Attachment C-5 (Screenshots Spanish) 2-6-14.pdf
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Immunization Management
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
441
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
Requested
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
441
0
0
0
0
441
Annual IC Time Burden (Hours)
221
0
0
0
0
221
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Non-smoker Survey Wave 2 - Word
Attachment C-5 Nonsmoker Follow-Up Survey (Waves 2-5) 2-6-14.docx
02/10/2014
Non-smoker Survey Wave 2 - 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.