OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

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

IC 228807 under ICR 201902-0910-011 · OMB 0910-0851.

Documents and Forms
Document Name
Document Type
Other-Wave 2, 3, 4 Consent Form
Other-Waves 2, 3, 4 Evaluation Quest
Information Collection (IC) Details

View Information Collection (IC)

Adult smokers ages 25 to 54; Wave 2 - 4 Questionnaires
 
No Unchanged
 
Voluntary
 

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

Health Consumer Health and Safety

 

2,938 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 2,938 0 0 0 0 2,938
Annual IC Time Burden (Hours) 1,968 0 0 0 0 1,968
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.