OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Hookah Purchase Journey: Online Hookah User Survey

IC 235192 under ICR 201907-0910-006 · OMB 0910-0810.

Documents and Forms
Document Name
Document Type
Other-Consent Form
Other-Screener
Other-Questionnaire
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Hookah Purchase Journey: Online Hookah User Survey CTP
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Consent Form Attachment A - Consent Form.pdf Yes Yes Fillable Printable
Other-Screener Attachment B - Screener.pdf Yes Yes Fillable Printable
Other-Questionnaire Attachment C - Questionnaire v2.docx Yes Yes Fillable Printable

Health Consumer Health and Safety

 

5,000 0
   
Individuals or Households
 
   100 %

  Requested 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 5,000 0 0 0 0 5,000
Annual IC Time Burden (Hours) 1,390 0 0 0 0 1,390
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Part A - Quantitative Supporting Statement Part A - Quantitative Supporting Statement (General Market).pdf 03/06/2019
Part B - Quantitative Supporting Statement Part B - Quantitative Supporting Statement (General Market).pdf 03/06/2019
IRB Approval Exemption Attachment D- IRB approval_exemption.pdf 03/06/2019
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.