OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Smoker Wave 1 Survey

IC 200739 under ICR 201411-0920-011 · OMB 0920-0923.

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

View Information Collection (IC)

Smoker Wave 1 Survey
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction none Smoker Wave 1 Questionnaire - screenshots Attachment C-2 (Screenshots) 2-6-14.pdf Yes Yes Fillable Fileable
Form none Smoker Wave 1 Questionnaire - Spanish screenshots Attachment C-2 (Screenshots Spanish) 2-6-14.pdf Yes Yes Fillable Fileable

Health Immunization Management

 

4,720 0
   
Individuals or Households
 
   100 %

  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 4,720 0 0 0 0 4,720
Annual IC Time Burden (Hours) 2,360 0 0 0 0 2,360
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Smoker Wave 1 Questionnaire - Spanish word Attachment C-2 (Spanish) 2-6-14.docx 02/10/2014
Smoker Wave 1 Questionnaire - word Attachment C-2 Smoker Wave 1 Survey_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.