Information Collection

Adult smokers ages 25 to 54; Wave 1 Questionnaire

IC 228781 under ICR 201902-0910-011 · OMB 0910-0851.

Documents and Forms

Documents and forms in this information collection
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

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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 1 Evaluation Consent					Yes	Yes	Fillable Fileable
Other-Evaluation Questionnaire					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 %

table that charts list of burden
	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

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.

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].