OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Adult smokers ages 25 to 54; Wave 1 Questionnaire

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

Documents and Forms
Document Name
Document Type
Other-Wave 1 Evaluation Consent
Other-Evaluation Questionnaire
Information Collection (IC) Details

View Information Collection (IC)

Adult smokers ages 25 to 54; Wave 1 Questionnaire
 
No Unchanged
 
Voluntary
 

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

Health Consumer Health and Safety

 

1,427 0
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1,427 0 0 0 0 1,427
Annual IC Time Burden (Hours) 956 0 0 0 0 956
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.