Evaluation of the National Tobacco Prevention and Control Public Education Campaign

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Non-smoker follow-up survey waves 2-4 Spanish	Form	Modified	Available
Non-smoker follow-up survey waves 2-4	Form	Modified	Available
Non-smoker follow-up survey waves 2-4 Spanish	Form	Modified	Available
Non-smoker follow-up survey waves 2-4	Form	Modified	Repair queued
Non-smoker follow-up survey waves 2-5 Spanish	Form	Modified	Available
Non-smoker follow-up survey waves 2-5	Form	Modified	Available
Smoker follow-up survey waves 2-5	Form	Modified	Repair queued
Smoker follow-up survey waves 2-5 Spanish	Form	Modified	Available
Smoker follow-up survey waves 2-5 Spanish	Form	Modified	Repair queued
Smoker follow-up survey waves 2-5	Form	Modified	Available
Smoker follow-up survey waves 2-5 Spanish	Form	Modified	Available
Smoker follow-up survey waves 2-5	Form	Modified	Available
Smoker follow-up survey waves 2-5 Spanish	Form	Modified	Available
Smoker follow-up survey waves 2-5	Form	Modified	Available
Non-smoker Survey Wave 1 screenshots	Form	Unchanged	Available
Non-smoker Survey Wave 1 - Spanish screenshots	Form	Unchanged	Available
Smoker Wave 1 Questionnaire - Spanish screenshots	Form	Unchanged	Available
Smoker Wave 1 Questionnaire - screenshots	Form and Instruction	Unchanged	Available
Screening Questionnaire - screenshots	Form	Unchanged	Available
Screening Questionnaire - Spanish Screenshots	Form	Unchanged	Repair queued
0920-0923 Change Request Justification_11-20-14.docx	Supplementary Document	Uploaded 2014-11-20	Available
0920-0923 Change Request Justification_9 04 2014.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2014-09-04	Available
Attachment G-3 ABS Sample Post Card Reminders.docx	Supplementary Document	Uploaded 2014-02-10	Available
Attachment G-2 KnowledgePanel Email Invitation Reminders 1-15-14.doc	Supplementary Document	Uploaded 2014-02-10	Available
Attachment G-1 ABS Sample Invitation Letter 2 6 2014.docx	Supplementary Document	Uploaded 2014-02-10	Available
Attachment F-1 GfK Privacy and Security Procedures.doc	Supplementary Document	Uploaded 2014-02-10	Available
Attachment E-1 RTI IRB Approval Notice.pdf	Supplementary Document	Uploaded 2014-02-10	Available
Attachment D-1 KnowledgePanel Recruitment Procedures.DOC	Supplementary Document	Uploaded 2014-02-10	Available
Attachment C-6 Summary of Key Construct Changes.docx	Supplementary Document	Uploaded 2014-02-10	Available
Attachment B-2 Summary of Public Comments.pdf	Supplementary Document	Uploaded 2014-02-10	Available
Attachment B-1 Federal Register Notice.pdf	Supplementary Document	Uploaded 2014-02-10	Available
Attachment A-3 PPHF.pdf	Supplementary Document	Uploaded 2014-02-10	Available
Attachment A-2 Familly Smoking Prevention & Tobacco Control Act.PDF	Supplementary Document	Uploaded 2014-02-10	Available
Attachment A-1 Public Health Service Act.doc	Supplementary Document	Uploaded 2014-02-10	Available
Attachment C-5 (Spanish) 2-6-14.docx	Supplementary Document	Uploaded 2014-02-10	Available
Attachment C-5 (Spanish) 2-6-14.docx	Supplementary Document	Uploaded 2014-02-10	Available
Attachment C-5 Nonsmoker Follow-Up Survey (Waves 2-5) 2-6-14.docx	Supplementary Document	Uploaded 2014-02-10	Available
Attachment C-5 (Spanish) 2-6-14.docx	Supplementary Document	Uploaded 2014-02-10	Available
Attachment C-5 Nonsmoker Follow-Up Survey (Waves 2-5) 2-6-14.docx	Supplementary Document	Uploaded 2014-02-10	Available
Attachment C-3 (Spanish) 2-6-14.docx	Supplementary Document	Uploaded 2014-02-10	Available
Attachment C-3 Smoker Follow-Up Survey (Waves 2-5)_2-6-14.docx	Supplementary Document	Uploaded 2014-02-10	Repair queued
Attachment C-3 (Spanish) 2-6-14.docx	Supplementary Document	Uploaded 2014-02-10	Available
Attachment C-3 Smoker Follow-Up Survey (Waves 2-5)_2-6-14.docx	Supplementary Document	Uploaded 2014-02-10	Available
Attachment C-3 (Spanish) 2-6-14.docx	Supplementary Document	Uploaded 2014-02-10	Available
Attachment C-3 Smoker Follow-Up Survey (Waves 2-5)_2-6-14.docx	Supplementary Document	Uploaded 2014-02-10	Available
Attachment C-3 (Spanish) 2-6-14.docx	Supplementary Document	Uploaded 2014-02-10	Available
Attachment C-2 (Spanish) 2-6-14.docx	Supplementary Document	Uploaded 2014-02-10	Available
Attachment C-2 Smoker Wave 1 Survey_2-6-14.docx	Supplementary Document	Uploaded 2014-02-10	Available
Attachment C-4 Nonsmoker Wave 1 Survey 2-6-14.docx	Supplementary Document	Uploaded 2014-02-10	Available
Attachment C-4 (Spanish) 2-6-14.docx	Supplementary Document	Uploaded 2014-02-10	Available
Attachment C-2 Smoker Wave 1 Survey_2-6-14.docx	Supplementary Document	Uploaded 2014-02-10	Available
Attachment C-2 (Spanish) 2-6-14.docx	Supplementary Document	Uploaded 2014-02-10	Available
Attachment C-1 Screening Questionnaire 2-6-14 (FINAL).docx	Supplementary Document	Uploaded 2014-02-10	Available
Attachment C-1 (Spanish) 2-6-14.doc	Supplementary Document	Uploaded 2014-02-10	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
210363	Non-smoker Follow-up Survey Wave 4	Form	Modified	Non-smoker follow-up survey waves 2-4 Spanish
210363	Non-smoker Follow-up Survey Wave 4	Form	Modified	Non-smoker follow-up survey waves 2-4
210362	Non-smoker Follow-up Survey Wave 3	Form	Modified	Non-smoker follow-up survey waves 2-4 Spanish
210362	Non-smoker Follow-up Survey Wave 3	Form	Modified	Non-smoker follow-up survey waves 2-4
210361	Non-smoker Follow-up Survey Wave 2	Form	Modified	Non-smoker follow-up survey waves 2-5 Spanish
210361	Non-smoker Follow-up Survey Wave 2	Form	Modified	Non-smoker follow-up survey waves 2-5
210360	Smoker Follow-up Survey Wave 5	Form	Modified	Smoker follow-up survey waves 2-5
210360	Smoker Follow-up Survey Wave 5	Form	Modified	Smoker follow-up survey waves 2-5 Spanish
210359	Smoker Follow-up Survey Wave 4	Form	Modified	Smoker follow-up survey waves 2-5 Spanish
210359	Smoker Follow-up Survey Wave 4	Form	Modified	Smoker follow-up survey waves 2-5
210358	Smoker Follow-up Survey Wave 3	Form	Modified	Smoker follow-up survey waves 2-5 Spanish
210358	Smoker Follow-up Survey Wave 3	Form	Modified	Smoker follow-up survey waves 2-5
210357	Smoker Follow-up Survey Wave 2	Form	Modified	Smoker follow-up survey waves 2-5 Spanish
210357	Smoker Follow-up Survey Wave 2	Form	Modified	Smoker follow-up survey waves 2-5
200741	Non-Smoker Survey Wave 1	Form	Unchanged	Non-smoker Survey Wave 1 screenshots
200741	Non-Smoker Survey Wave 1	Form	Unchanged	Non-smoker Survey Wave 1 - Spanish screenshots
200739	Smoker Wave 1 Survey	Form	Unchanged	Smoker Wave 1 Questionnaire - Spanish screenshots
200739	Smoker Wave 1 Survey	Form and Instruction	Unchanged	Smoker Wave 1 Questionnaire - screenshots
200737	Screening and Consent	Form	Unchanged	Screening Questionnaire - screenshots
200737	Screening and Consent	Form	Unchanged	Screening Questionnaire - Spanish Screenshots

ICR Details

OMB Control No: 0920-0923	ICR Reference No: 201411-0920-011
Status: Historical Active	Previous ICR Reference No: 201409-0920-003
Agency/Subagency: HHS/CDC	Agency Tracking No: 21420
Title: Evaluation of the National Tobacco Prevention and Control Public Education Campaign
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/12/2014
Retrieve Notice of Action (NOA)	Date Received in OIRA: 11/24/2014
Terms of Clearance: Previous terms continue: All communications about the evaluation results via these uses of the information, including any and all Congressional testimony, will carefully enumerate and describe any underlying limitations of the data and ensure that evaluation results are interpreted with appropriate care and caution. CDC acknowledges that study design limitations decrease their capacity to draw nationally representative conclusions about either smoking-related knowledge and behavior or the impact of the campaign on long-term quit rates in sub-populations. Also, approval of any future tobacco-related campaign evaluations (including future revisions of this package) will require a coordinated approach among federal partners (including CDC, FDA, NIH, and SAMHSA) on outcome measures and questionnaire items. Future data collection requests related to tobacco will include a section in supporting statement Part A describing this collaboration and what steps have been made to harmonize data elements and outcome measures as well as a description of steps taken to eliminate duplication of effort across the federal government in the area of tobacco information collection. Areas where there may be significant overlap include, but are not limited to, cessation behavior, perceptions of health risk, health status, etc.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2017	03/31/2017	03/31/2017
Responses	28,447	0	28,447
Time Burden (Hours)	8,777	0	8,777
Cost Burden (Dollars)	0	0	0

---

Abstract: CDC requests non-substantive changes to some of the survey instruments to capture changes in landscape of tobacco use and nicotine products.

---

Authorizing Statute(s): PL: Pub.L. 111 - 148 4004 Name of Law: Patient Protection and Affordable Care Act
   PL: Pub.L. 111 - 31 203 Name of Law: Family Smoking Prevention and Tobacco Control Act
   US Code: 42 USC 301 Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 69680	11/20/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 8910	02/11/2014
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 10

table that charts list of burden

IC Title	Form No.	Form Name
Non-Smoker Survey Wave 1	none, none	Non-smoker Survey Wave 1 - Spanish screenshots ,   Non-smoker Survey Wave 1 screenshots
Non-smoker Follow-up Survey Wave 2	none, none	Non-smoker follow-up survey waves 2-5 ,   Non-smoker follow-up survey waves 2-5 Spanish
Non-smoker Follow-up Survey Wave 3	none, none	Non-smoker follow-up survey waves 2-4 ,   Non-smoker follow-up survey waves 2-4 Spanish
Non-smoker Follow-up Survey Wave 4	none, none	Non-smoker follow-up survey waves 2-4 ,   Non-smoker follow-up survey waves 2-4 Spanish
Screening and Consent	none, none	Screening Questionnaire - Spanish Screenshots ,   Screening Questionnaire - screenshots
Smoker Follow-up Survey Wave 2	none, none	Smoker follow-up survey waves 2-5 ,   Smoker follow-up survey waves 2-5 Spanish
Smoker Follow-up Survey Wave 3	none, none	Smoker follow-up survey waves 2-5 Spanish ,   Smoker follow-up survey waves 2-5
Smoker Follow-up Survey Wave 4	none, none	Smoker follow-up survey waves 2-5 ,   Smoker follow-up survey waves 2-5 Spanish
Smoker Follow-up Survey Wave 5	none, none	Smoker follow-up survey waves 2-5 ,   Smoker follow-up survey waves 2-5 Spanish
Smoker Wave 1 Survey	none, none	Smoker Wave 1 Questionnaire - screenshots ,   Smoker Wave 1 Questionnaire - Spanish screenshots

---

ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	28,447	28,447	0	0	0	0
Annual Time Burden (Hours)	8,777	8,777	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government: $3,329,673

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Yes

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 11/24/2014

---