Information Collection Request

Extended Evaluation of the National Tobacco Prevention and Control Public Education Campaign

ICR 201709-0920-003 · OMB 0920-1083 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Nonsmoker Survey - Wave E (English and Spanish) Form and Instruction New Available
Smoker Survey - Wave E (English and Spanish) Form and Instruction New Available
Smoker Survey - Wave A (English and Spanish) Form and Instruction Modified Available
Nonsmoker Survey - Wave D (English and Spanish) Form and Instruction Modified Available
Nonsmoker Survey - Wave C (English and Spanish) Form and Instruction Modified Available
Nonsmoker Survey - Wave B (English and Spanish) Form and Instruction Modified Available
Nonsmoker Survey - Wave A (English and Spanish) Form and Instruction Modified Available
Smoker Suvey - Wave D (English and Spanish) Form and Instruction Modified Available
Smoker Survey - Wave C (English and Spanish) Form and Instruction Modified Available
Smoker Survey - Wave B Form and Instruction Modified Repair queued
Screening and Consent Form and Instruction Modified Available
Attachment J. Source of Respondents for Each Wave of Data Collection.docx Supplementary Document Uploaded 2017-10-17 Available
Attachment I-3. ABS Sample Postcard Reminders.docx Supplementary Document Uploaded 2017-10-17 Available
Attachment I-2. KnowledgePanel Email Invitation Reminders.doc Supplementary Document Uploaded 2017-10-17 Available
Attachment I-1. ABS Sample Invitation Letter.docx Supplementary Document Uploaded 2017-10-17 Available
Attachment H. GfK Privacy and Security Procedures.doc Supplementary Document Uploaded 2017-10-17 Available
Attachment G. IRB Approval Notice.pdf Supplementary Document Uploaded 2017-10-17 Available
Attachment F. KnowledgePanel Recruitment Procedures.doc Supplementary Document Uploaded 2017-10-17 Available
Attachment E-2. Changes to Waves A-E Nonsmoker Survey.docx Supplementary Document Uploaded 2017-10-17 Available
Attachment D-2. Changes to Waves A-E Smoker Survey (Revised 4-11-17).docx Supplementary Document Uploaded 2017-10-17 Available
Attachment B. 60-Day Federal Register Notice.pdf Supplementary Document Uploaded 2017-10-17 Available
Att A-3. PPHF.pdf Supplementary Document Uploaded 2015-06-24 Available
Att A-2. Familly Smoking Prevention & Tobacco Control Act.pdf Supplementary Document Uploaded 2015-06-24 Available
Att A-1. Public Health Service Act.doc Supplementary Document Uploaded 2015-06-24 Available
Part B_Evaluation ICR_10-17-2017.docx Supporting Statement B Uploaded 2017-10-17 Available
Part A_Evaluation ICR_10-17-2017.docx Supporting Statement A Uploaded 2017-10-17 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
228674 Nonsmoker Survey - Wave E (English and Spanish) Form and Instruction NewNonsmoker Survey - Wave E (English and Spanish)
228673 Smoker Survey - Wave E (English and Spanish) Form and Instruction NewSmoker Survey - Wave E (English and Spanish)
218056 Smoker Survey - Wave A (English and Spanish) Form and Instruction ModifiedSmoker Survey - Wave A (English and Spanish)
217194 Non-smoker Survey - Wave D (English and Spanish) Form and Instruction ModifiedNonsmoker Survey - Wave D (English and Spanish)
217193 Non-smoker Survey - Wave C (English and Spanish) Form and Instruction ModifiedNonsmoker Survey - Wave C (English and Spanish)
217192 Non-smoker Survey - Wave B (English and Spanish) Form and Instruction ModifiedNonsmoker Survey - Wave B (English and Spanish)
217191 Non-smoker Survey - Wave A (English and Spanish) Form and Instruction ModifiedNonsmoker Survey - Wave A (English and Spanish)
217190 Smoker Survey - Wave D (English and Spanish) Form and Instruction ModifiedSmoker Suvey - Wave D (English and Spanish)
217189 Smoker Survey - Wave C (English and Spanish) Form and Instruction ModifiedSmoker Survey - Wave C (English and Spanish)
217188 Smoker Survey - Wave B (English and Spanish) Form and Instruction ModifiedSmoker Survey - Wave B
217186 Screening and Consent (English and Spanish) Form and Instruction ModifiedScreening and Consent

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
02/29/2020 24 Months From Approved
58,000 0 0
18,583 0 0
433,980 0 0





Reginfo record details
11
table that charts list of burden
IC Title Form No. Form Name
Non-smoker Survey - Wave A (English and Spanish) n/a
Non-smoker Survey - Wave B (English and Spanish) n/a
Non-smoker Survey - Wave C (English and Spanish) n/a
Non-smoker Survey - Wave D (English and Spanish) n/a
Nonsmoker Survey - Wave E (English and Spanish) n/a
Screening and Consent (English and Spanish) n/a
Smoker Survey - Wave A (English and Spanish) n/a
Smoker Survey - Wave B (English and Spanish) n/a
Smoker Survey - Wave C (English and Spanish) n/a
Smoker Survey - Wave D (English and Spanish) n/a
Smoker Survey - Wave E (English and Spanish) n/a

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 58,000 0 0 58,000 0 0
Annual Time Burden (Hours) 18,583 0 0 18,583 0 0
Annual Cost Burden (Dollars) 433,980 0 0 433,980 0 0


Reginfo record details
  No