Adult smokers ages 25 to 54; Wave 1 Questionnaire

Evaluation of the Food and Drug Administration’s Point-of-Sale Campaign

Documents and Forms

Document Name Document Type
Attachment_03a_POSITEv_Wave_1_evaluation_consent Clean.docx Other-Wave 1 Evaluation Consent
Attachment_02b_evaluation_questionnaire_Waves_2_3_4.docx Other-Evaluation Questionnaire

Information Collection (IC) Details

IC Title:	Adult smokers ages 25 to 54; Wave 1 Questionnaire	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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-Wave 1 Evaluation Consent			Attachment_03a_POSITEv_Wave_1_evaluation_consent Clean.docx		Yes	Yes	Fillable Fileable
Other-Evaluation Questionnaire			Attachment_02b_evaluation_questionnaire_Waves_2_3_4.docx		Yes	Yes	Fillable Fileable Signable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,427	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	1,427	1,427
Annual IC Time Burden (Hours)	956	956
Annual IC Cost Burden (Dollars)	0	0

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.