Panel Replenishment Household Screening Respondent

National Panel of Tobacco Consumer Studies

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0815 can be found here:

Documents and Forms

Document Name Document Type
Attachment_1_Questionnaires_English_Clean_022520.pdf Other-Questionnaires - English
Attachment_2_Questionnaires_Spanish_Clean_022520.pdf Other-Questionnaires - Spanish

Information Collection (IC) Details

IC Title:	Panel Replenishment Household Screening Respondent	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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-Questionnaires - English			Attachment_1_Questionnaires_English_Clean_022520.pdf		Yes	Yes	Fillable Fileable
Other-Questionnaires - Spanish			Attachment_2_Questionnaires_Spanish_Clean_022520.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 38,280	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	12,632	2,347	10,285
Annual IC Time Burden (Hours)	1,642	304	1,338
Annual IC Cost Burden (Dollars)	0	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.