Information Collection Request

Extended Evaluation of the National Tobacco Prevention and Control Public Education Campaign

ICR 201909-0920-005 · OMB 0920-1083 · Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 0920-1083 Nonsmoker Survey - Wave I (English and Spanish) Form and Instruction New Available
Form 0920-1083 Nonsmoker Survey - Wave H (English and Spanish) Form and Instruction New Repair queued
Form 0920-1083 Nonsmoker Survey - Wave G (English and Spanish) Form and Instruction New Available
Form 0920-1083 Nonsmoker Survey - Wave F (English and Spanish) Form and Instruction New Available
Form 0920-1083 Smoker Survery - Wave I (English and Spanish) Form and Instruction New Available
Form 0920-1083 Smoker Survery - Wave H (English and Spanish) Form and Instruction New Repair queued
Form 0920-1083 Smoker Survery - Wave G (English and Spanish) Form and Instruction New Available
Form 0920-1083 Smoker Survery - Wave F (English and Spanish) Form and Instruction New Available
Form 0920-1083 Nonsmoker Survey - Wave E (English and Spanish) Form and Instruction Modified Available
Form 0920-1083 Smoker Survey - Wave E (English and Spanish) Form and Instruction Modified Available
Form 0920-1083 Smoker Survey - Wave A (English and Spanish) Form and Instruction Modified Available
Form 0920-1083 Non-smoker Survey - Wave D (English and Spanish) Form and Instruction Modified Available
Form 0920-1083 Non-smoker Survey - Wave C (English and Spanish) Form and Instruction Modified Repair queued
Form 0920-1083 Non-smoker Survey - Wave B (English and Spanish) Form and Instruction Modified Available
Form 0920-1083 Non-smoker Survey - Wave A (English and Spanish) Form and Instruction Modified Available
Form 0920-1083 Smoker Survey - Wave D (English and Spanish) Form and Instruction Modified Available
Form 0920-1083 Smoker Survey - Wave C (English and Spanish) Form and Instruction Modified Repair queued
Form 0920-1083 Smoker Survey - Wave B (English and Spanish) Form and Instruction Modified Available
Form 0920-1083 Screening and Consent (English and Spanish) Form and Instruction Modified Available
684_NTEC.pdf Supplementary Document Uploaded 2019-10-07 Available
Privacy Narrative PDF OMB 0920_1083_12_19_18 signed 09-12-19.pdf Supplementary Document Uploaded 2019-10-07 Available
Attachment J. Source of Respondents for Each Wave of Data Collection.docx Supplementary Document Uploaded 2019-10-07 Available
Attachment I-3. ABS Sample Postcard Reminders.pdf Supplementary Document Uploaded 2019-10-07 Available
Attachment I-2. KnowledgePanel Email Invitation Reminders.doc Supplementary Document Uploaded 2019-10-07 Available
Attachment I-1. ABS Sample Invitation Letters.pdf Supplementary Document Uploaded 2019-10-07 Available
Attachment H. GfK-Ipsos Privacy and Security Procedures.doc Supplementary Document Uploaded 2019-10-07 Available
Attachment G. RTI IRB Approval Notice.pdf Supplementary Document Uploaded 2019-10-07 Available
Attachment F. KnowledgePanel Recruitment Procedures.doc Supplementary Document Uploaded 2019-10-07 Available
Attachment E-3. Changes to Wave A-I Nonsmoker Survey 12-5-18.docx Supplementary Document Uploaded 2019-10-07 Repair queued
Attachment D-3. Changes to Wave A-I Smoker Survey Updated.docx Supplementary Document Uploaded 2019-10-09 Available
Attachment B-1. 60-Day FRN Published 4-23-19.pdf Supplementary Document Uploaded 2019-10-07 Available
Attachment A-3. PPHF.pdf Supplementary Document Uploaded 2019-10-07 Available
Attachment A-2. Familly Smoking Prevention & Tobacco Control Act.PDF Supplementary Document Uploaded 2019-10-07 Available
Attachment A-1. Public Health Service Act.doc Supplementary Document Uploaded 2019-10-07 Available
Part B_Evaluation ICR_6-10-19.docx Supporting Statement B Uploaded 2019-10-07 Available
Part A_Evaluation ICR_6-10-19 final.docx Supporting Statement A Uploaded 2019-10-07 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
237915 Nonsmoker Survey - Wave I (English and Spanish) Form and Instruction New
237914 Nonsmoker Survey - Wave H (English and Spanish) Form and Instruction New
237912 Nonsmoker Survey - Wave G (English and Spanish) Form and Instruction New
237911 Nonsmoker Survey - Wave F (English and Spanish) Form and Instruction New
237910 Smoker Survery - Wave I (English and Spanish) Form and Instruction New
237909 Smoker Survery - Wave H (English and Spanish) Form and Instruction New
237907 Smoker Survery - Wave G (English and Spanish) Form and Instruction New
237906 Smoker Survery - Wave F (English and Spanish) Form and Instruction New
228674 Nonsmoker Survey - Wave E (English and Spanish) Form and Instruction Modified
228673 Smoker Survey - Wave E (English and Spanish) Form and Instruction Modified
218056 Smoker Survey - Wave A (English and Spanish) Form and Instruction Modified
217194 Non-smoker Survey - Wave D (English and Spanish) Form and Instruction Modified
217193 Non-smoker Survey - Wave C (English and Spanish) Form and Instruction Modified
217192 Non-smoker Survey - Wave B (English and Spanish) Form and Instruction Modified
217191 Non-smoker Survey - Wave A (English and Spanish) Form and Instruction Modified
217190 Smoker Survey - Wave D (English and Spanish) Form and Instruction Modified
217189 Smoker Survey - Wave C (English and Spanish) Form and Instruction Modified
217188 Smoker Survey - Wave B (English and Spanish) Form and Instruction Modified
217186 Screening and Consent (English and Spanish) Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
03/31/2023 36 Months From Approved 03/31/2020
40,434 0 58,000
9,308 0 18,583
232,096 0 433,980





Reginfo record details
19
table that charts list of burden
IC Title Form No. Form Name
Non-smoker Survey - Wave A (English and Spanish) 0920-1083, 0920-1083 Nonsmoker Survey - Wave A ,   Nonsmoker Survey - Wave A Spanish
Screening and Consent (English and Spanish) 0920-1083, 0920-1083 Screener and Consent Spanish ,   Screening and Consent
Smoker Survey - Wave B (English and Spanish) 0920-1083, 0920-1083 Smoker Survey - Wave B Spanish ,   Smoker Survey - Wave B
Smoker Survey - Wave C (English and Spanish) 0920-1083, 0920-1083 Smoker Survey - Wave C ,   Smoker Survey -- Wave C Spanish
Smoker Survey - Wave D (English and Spanish) 0920-1083, 0920-1083 Smoker Suvey - Wave D ,   Smoker Survey - Wave D Spanish
Non-smoker Survey - Wave B (English and Spanish) 0920-1083, 0920-1083 Nonsmoker Survey - Wave B ,   Nonsmoker Survey - Wave B Spanish
Non-smoker Survey - Wave C (English and Spanish) 0920-1083, 0920-1083 Nonsmoker Survey - Wave C ,   Nonsmoker Survey - Wave C Spanish
Non-smoker Survey - Wave D (English and Spanish) 0920-1083, 0920-1083 Nonsmoker Survey - Wave D ,   Nonsmoker Survey - Wave D Spanish
Smoker Survey - Wave A (English and Spanish) 0920-1083, 0920-1083 Smoker Survey - Wave A ,   Smoker Suvey - Wave A Spanish
Nonsmoker Survey - Wave E (English and Spanish) 0920-1083, 0920-1083 Nonsmoker Survey - Wave E ,   Nonsmoker Survey - Wave E Spanish
Smoker Survey - Wave E (English and Spanish) 0920-1083, 0920-1083 Smoker Survey - Wave E ,   Smoker Survey - Wave E Spanish
Smoker Survery - Wave F (English and Spanish) 0920-1083, 0920-1083 Smoker Survey - Wave F ,   Smoker Survey - Wave F Spanish
Smoker Survery - Wave G (English and Spanish) 0920-1083, 0920-1083 Smoker Survey - Wave G ,   Smoker Survey - Wave G Spanish
Smoker Survery - Wave H (English and Spanish) 0920-1083, 0920-1083 Smoker Survey - Wave H ,   Smoker Survey - Wave H Spanish
Smoker Survery - Wave I (English and Spanish) 0920-1083, 0920-1083 Smoker Survey - Wave I Spanish ,   Smoker Survey - Wave I
Nonsmoker Survey - Wave F (English and Spanish) 0920-1083, 0920-1083 Nonsmoker Survey - Wave F ,   Nonsmoker Survey - Wave F Spanish
Nonsmoker Survey - Wave G (English and Spanish) 0920-1083, 0920-1083 Nonsmoker Survey - Wave G ,   Nonsmoker Survey - Wave G Spanish
Nonsmoker Survey - Wave H (English and Spanish) 0920-1083, 0920-1083 Nonsmoker Survey - Wave H ,   Nonsmoker Survey - Wave H Spanish
Nonsmoker Survey - Wave I (English and Spanish) 0920-1083, 0920-1083 Nonsmoker Survey - Wave I ,   Nonsmoker Survey - Wave I Spanish

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 40,434 58,000 0 -25,899 8,333 0
Annual Time Burden (Hours) 9,308 18,583 0 -12,051 2,776 0
Annual Cost Burden (Dollars) 232,096 433,980 0 -240,768 38,884 0


Reginfo record details
  No