Panel Replenishment Household Screening Respondent

National Panel of Tobacco Consumer Studies

Documents and Forms

Document Name Document Type
Attachment_1_Questionnaires_English_CLEAN_042220.pdf Other-Questionnaires - English
Attachment_2_Questionnaires_Spanish_CLEAN_042220.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_042220.pdf		Yes	Yes	Fillable Fileable
Other-Questionnaires - Spanish			Attachment_2_Questionnaires_Spanish_CLEAN_042220.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	Previously Approved
Annual Number of Responses for this IC	12,632	12,632
Annual IC Time Burden (Hours)	1,642	1,642
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.