Information Collection

Be Tobacco Free.HHS.gov site Wide satisfaction Survey

IC 226345 under ICR 201503-0990-001 · OMB 0990-0379.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0379 can be found here:

Documents and Forms

Document Name Document Type
0990-0379_BeTobaccoFree.hhs.gov-Site-Wide-Satisfaction-Survey-updated.docx Other-survey
0990-0379 Generic Clearance Submission-BeTobaccoFree.hhs.gov Site-Wide Satisfaction Survey.docx memo IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Be Tobacco Free.HHS.gov site Wide satisfaction Survey	Agency IC Tracking Number:

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
Other-survey			0990-0379_BeTobaccoFree.hhs.gov-Site-Wide-Satisfaction-Survey-updated.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 7,500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	7,500	7,500
Annual IC Time Burden (Hours)	625	625
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
memo	0990-0379 Generic Clearance Submission-BeTobaccoFree.hhs.gov Site-Wide Satisfaction Survey.docx	04/11/2017

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