Information Collection

[NCCDPHP] Focus Groups with Adults who Smoke Cigarettes (2023)

IC 259269 under ICR 202009-0920-009 · OMB 0920-0910.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0910 can be found here:

2025-03-28 - No material or nonsubstantive change to a currently approved collection
2024-09-24 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Focus Group Recruitment Screener [NCCDPHP] Focus Groups with Adults who Smoke Cigarettes (2023)	Form and Instruction
Pre-Focus Group Questionnaire (screenshots) [NCCDPHP] Focus Groups with Adults who Smoke Cigarettes (2023)	Form and Instruction
In-Person Focus Group Moderator's Guide [NCCDPHP] Focus Groups with Adults who Smoke Cigarettes (2023)	Form and Instruction
Online Focus Group Moderator's Guide [NCCDPHP] Focus Groups with Adults who Smoke Cigarettes (2023)	Form and Instruction
Post-Focus Group Questionnaire (screenshots) [NCCDPHP] Focus Groups with Adults who Smoke Cigarettes (2023)	Form and Instruction
Focus Group Recruitment Screener 0910 Attachment 2 - Focus Group Recruitment Screener_20221216_clean.docx	Form and Instruction
Pre-Focus Group Questionnaire (screenshots) 0910 Attachment 5 - Pre-Focus Group Questionnaire Screenshots_03232027.pdf	Form and Instruction
In-Person Focus Group Moderator's Guide 0910 Attachment 6 - In-Person Focus Group Moderator's Guide_20230327.docx	Form and Instruction
Online Focus Group Moderator's Guide 0910 Attachment 7 - Online Focus Group Moderator's Guide_20230327.docx	Form and Instruction
Post-Focus Group Questionnaire (screenshots) 0910 Attachment 8 - Post-Focus Group Questionnaire Screenshots_03232027.pdf	Form and Instruction
0910 SSA_Focus groups with adults who smoke cigarettes_20230327 revised.docx Supporting Statement Part A	IC Document
0910 SSB_Focus groups with adults who smoke cigarettes_20230327.docx Supporting Statement Part B	IC Document
Attachment 1 - Schlesinger Privacy Policy.docx Privacy Policy of Data Collection Contractor	IC Document
0910 Attachment 3 - Informed Consent for In-Person Focus Groups_20230327.docx Informed Consent for In-person Focus Groups	IC Document
0910 Attachment 4 - Informed Consent for Online Focus Groups Screenshots_20230327.pdf Informed Consent for Online Focus Groups	IC Document
0910 Attachment 9 - Battelle Institutional Review Board Exemption.pdf Determination: IRB approval is not required	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

[NCCDPHP] Focus Groups with Adults who Smoke Cigarettes (2023)

Agency IC Tracking Number:

0920-0910-23DQ

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	None	Yes	Yes	Fillable Fileable
Form and Instruction	None	Yes	Yes	Fillable Fileable
Form and Instruction	None	No		Paper Only
Form and Instruction	None	Yes	Yes	Fillable Fileable
Form and Instruction	None	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5,108

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 90 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	5,108	5,108
Annual IC Time Burden (Hours)	1,361	1,361
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement Part A		03/31/2023
Supporting Statement Part B		03/31/2023
Privacy Policy of Data Collection Contractor		03/31/2023
Informed Consent for In-person Focus Groups		03/31/2023
Informed Consent for Online Focus Groups		03/31/2023
Determination: IRB approval is not required		03/31/2023

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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