Information Collection

Adult smokers ages 25 to 54; Wave 2 - 4 Questionnaires

IC 228807 under ICR 201810-0910-011 · OMB 0910-0851.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0851 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment_03c_POSITEv_Waves_2_3_4_consent clean.docx	Other-Wave 2, 3, 4 Consent Form
Attachment_2b_Waves_2_3_4_evaluation_questionnaire.docx	Other-Waves 2, 3, 4 Evaluation Quest

IC Title:

Adult smokers ages 25 to 54; Wave 2 - 4 Questionnaires

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Wave 2, 3, 4 Consent Form			Attachment_03c_POSITEv_Waves_2_3_4_consent clean.docx		Yes	Yes	Fillable Printable
Other-Waves 2, 3, 4 Evaluation Questionnaire			Attachment_2b_Waves_2_3_4_evaluation_questionnaire.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: 2,938

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	2,938	2,938
Annual IC Time Burden (Hours)	1,968	1,968
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.