Information Collection

Smoker Follow-up Survey Wave 4

IC 210359 under ICR 201409-0920-003 · OMB 0920-0923.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0923 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Smoker Follow-up Survey Wave 4	Form
Smoker Follow-up Survey (Waves 2-5) Screenshots C-3 Smoker Follow-Up Survey (Waves 2-5) Screenshots_9 04 2014.pdf	Form
Spanish Smoker Follow-up Survey (Waves 2-5) C-3 Smoker Follow-Up Survey (Waves 2-5)_SPANISH_9 04 2014.docx	Form

IC Title:

Smoker Follow-up Survey Wave 4

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Smoker Follow-up Survey (Waves 2-5) Screenshots	C-3 Smoker Follow-Up Survey (Waves 2-5) Screenshots_9 04 2014.pdf		Yes	Yes	Fillable Fileable
Form	none	Spanish Smoker Follow-up Survey (Waves 2-5)	C-3 Smoker Follow-Up Survey (Waves 2-5)_SPANISH_9 04 2014.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,982

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	1,982	1,982
Annual IC Time Burden (Hours)	991	991
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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