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

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

Documents and Forms

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

Information Collection (IC) Details

IC Title:	Adult smokers ages 25 to 54; Wave 2 - 4 Questionnaires	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 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 %

	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

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.