Smoker Survey - Wave E (English and Spanish)

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1083 can be found here:

Documents and Forms

Document Name Document Type
Smoker Survey - Wave E (English and Spanish) Form and Instruction
Smoker Survey - Wave E (English and Spanish) Attachment D-2. Changes to Waves A-E Smoker Survey (Revised 4-11-17).docx Form and Instruction

Information Collection (IC) Details

IC Title:	Smoker Survey - Wave E (English and Spanish)	Agency IC Tracking Number:

Is this a Common Form? No		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
Form and Instruction	n/a	Smoker Survey - Wave E (English and Spanish)	Attachment D-2. Changes to Waves A-E Smoker Survey (Revised 4-11-17).docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,000	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	4,000	4,000
Annual IC Time Burden (Hours)	2,000	2,000
Annual IC Cost Burden (Dollars)	46,680	46,680

Documents for IC

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.