OMB Control No: 0920-1083
ICR Reference No:
202106-0920-001
Status: Received in OIRA
Previous ICR Reference No: 201909-0920-005
Agency/Subagency: HHS/CDC
Agency Tracking No:
0920-1083-21FP
Title: Extended Evaluation of the
National Tobacco Prevention and Control Public Education
Campaign
Type of Information Collection: No
material or nonsubstantive change to a currently approved
collection
Common Form ICR: No
Type of Review Request: Regular
Date Submitted to OIRA:
06/07/2021
Requested
Previously Approved
Expiration Date
03/31/2023
03/31/2023
Responses
40,434
40,434
Time Burden (Hours)
9,308
9,308
Cost Burden (Dollars)
232,096
232,096
Abstract: This study will enable Centers for
Disease Control and Prevention (CDC) to continue to measure
exposure and awareness of the Tips From Former Smokers ® campaign
and to evaluate its impact on campaign-targeted outcomes among
smokers and nonsmokers in the United States. This Non-Substantive
Change Request is submitted to consider the potential impact of
COVID-19 on cigarette smoking cessation and the potential impact on
campaign outcomes.
Authorizing Statute(s): PL:
Pub.L. 111 - 148 4001 Name of Law: Affordable Care Act
PL:
Pub.L. 111 - 31 123 Name of Law: Family Smoking Prevention and
Tobacco Control
US Code: 42
USC 241 Name of Law: Public Health Service Act
Citations for New Statutory
Requirements: None
Associated Rulemaking
Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices &
Comments
60-day Notice:
Federal Register Citation:
Citation Date:
84 FR
16863
04/23/2019
30-day Notice:
Federal Register Citation:
Citation Date:
84 FR
54151
10/09/2019
Did the Agency receive public comments on
this ICR? No
Number of Information Collection (IC) in this
ICR: 19
IC Title
Form No.
Form Name
Non-smoker Survey -
Wave A (English and Spanish)
0920-1083, 0920-1083, 0920-1083, 0920-1083
Nonsmoker Survey -
Wave A , Nonsmoker Survey - Wave A
Spanish , Nonsmoker Survey Wave
A_English 04JUN2021 , Nonsmoker Survey Wave
A_Spanish 04JUN2021
Non-smoker Survey -
Wave B (English and Spanish)
0920-1083, 0920-1083, 0920-1083, 0920-1083
Nonsmoker Survey -
Wave B , Nonsmoker Survey - Wave B
Spanish , Nonsmoker Survey Wave
B_English 04JUN2021 , Nonsmoker Survey Wave
B_Spanish 04JUN2021
Non-smoker Survey -
Wave C (English and Spanish)
0920-1083, 0920-1083, 0920-1083, 0920-1083
Nonsmoker Survey -
Wave C , Nonsmoker Survey - Wave C
Spanish , Nonsmoker Survey Wave
C_English 04JUN2021 , Nonsmoker Survey Wave
C_Spanish 04JUN2021
Non-smoker Survey -
Wave D (English and Spanish)
0920-1083, 0920-1083, 0920-1083, 0920-1083
Nonsmoker Survey -
Wave D , Nonsmoker Survey - Wave D
Spanish , Nonsmoker Survey Wave
D_English 04JUN2021 , Nonsmoker Survey Wave
D_Spanish 04JUN2021
Nonsmoker Survey -
Wave E (English and Spanish)
0920-1083, 0920-1083, 0920-1083, 0920-1083
Nonsmoker Survey -
Wave E , Nonsmoker Survey - Wave E
Spanish , Nonsmoker Survey Wave
E_English 04JUN2021 , Nonsmoker Survey Wave
E_Spanish 04JUN2021
Nonsmoker Survey -
Wave F (English and Spanish)
0920-1083, 0920-1083, 0920-1083, 0920-1083
Nonsmoker Survey -
Wave F , Nonsmoker Survey - Wave F
Spanish , Nonsmoker Survey Wave
F_English 04JUN2021 , Nonsmoker Survey Wave
F_Spanish 04JUN2021
Nonsmoker Survey -
Wave G (English and Spanish)
0920-1083, 0920-1083, 0920-1083, 0920-1083
Nonsmoker Survey -
Wave G , Nonsmoker Survey - Wave G
Spanish , Nonsmoker Survey Wave
G_English 04JUN2021 , Nonsmoker Survey Wave
G_Spanish 04JUN2021
Nonsmoker Survey -
Wave H (English and Spanish)
0920-1083, 0920-1083, 0920-1083, 0920-1083
Nonsmoker Survey -
Wave H , Nonsmoker Survey - Wave H
Spanish , Nonsmoker Survey Wave
H_English 04JUN2021 , Nonsmoker Survey Wave
H_Spanish 04JUN2021
Nonsmoker Survey -
Wave I (English and Spanish)
0920-1083, 0920-1083, 0920-1083, 0920-1083
Nonsmoker Survey -
Wave I , Nonsmoker Survey - Wave I
Spanish , Nonsmoker Survey Wave
I_English 04JUN2021 , Nonsmoker Survey Wave
I_Spanish 04JUN2021
Screening and Consent
(English and Spanish)
0920-1083, 0920-1083
Screening and
Consent , Screener and Consent
Spanish
Smoker Survery - Wave
F (English and Spanish)
0920-1083, 0920-1083, 0920-1083, 0920-1083
Smoker Survey -
Wave F , Smoker Survey - Wave F
Spanish , Smoker Survey Wave F_English
04JUN2021 , Smoker Survey Wave F_Spanish
04JUN2021
Smoker Survery - Wave
G (English and Spanish)
0920-1083, 0920-1083, 0920-1083, 0920-1083
Smoker Survey -
Wave G , Smoker Survey - Wave G
Spanish , Smoker Survey Wave G_English
04JUN2021 , Smoker Survey Wave G_Spanish
04JUN2021
Smoker Survery - Wave
H (English and Spanish)
0920-1083, 0920-1083, 0920-1083, 0920-1083
Smoker Survey -
Wave H , Smoker Survey - Wave H
Spanish , Smoker Survey Wave H_English
04JUN2021 , Smoker Survey Wave H_Spanish
04JUN2021
Smoker Survery - Wave
I (English and Spanish)
0920-1083, 0920-1083, 0920-1083, 0920-1083
Smoker Survey -
Wave I , Smoker Survey - Wave I
Spanish , Smoker Survey Wave I_English
04JUN2021 , Smoker Survey Wave I_Spanish
04JUN2021
Smoker Survey - Wave A
(English and Spanish)
0920-1083, 0920-1083, 0920-1083, 0920-1083
Smoker Survey -
Wave A , Smoker Suvey - Wave A
Spanish , Smoker Survey Wave A_English
04JUN2021 , Smoker Survey Wave A_Spanish
04JUN2021
Smoker Survey - Wave B
(English and Spanish)
0920-1083, 0920-1083, 0920-1083, 0920-1083
Smoker Survey -
Wave B , Smoker Survey - Wave B
Spanish , Smoker Survey Wave B _English
04JUN2021 , Smoker Survey Wave B_Spanish
04JUN2021
Smoker Survey - Wave C
(English and Spanish)
0920-1083, 0920-1083, 0920-1083, 0920-1083
Smoker Survey -
Wave C , Smoker Survey -- Wave C
Spanish , Smoker Survey Wave C_English
04JUN2021 , Smoker Survey Wave C_Spanish
04JUN2021
Smoker Survey - Wave D
(English and Spanish)
0920-1083, 0920-1083, 0920-1083, 0920-1083
Smoker Suvey -
Wave D , Smoker Survey - Wave D
Spanish , Smoker Survey Wave D_English
04JUN2021 , Smoker Survey Wave D_Spanish
04JUN2021
Smoker Survey - Wave E
(English and Spanish)
0920-1083, 0920-1083, 0920-1083, 0920-1083
Smoker Survey -
Wave E , Smoker Survey - Wave E
Spanish , Smoker Survey Wave E_English
04JUN2021 , Smoker Survey Wave E_Spanish
04JUN2021
ICR Summary of Burden
Total Request
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
40,434
0
0
0
0
Annual Time Burden (Hours)
9,308
9,308
0
0
0
0
Annual Cost Burden (Dollars)
232,096
232,096
0
0
0
0
Burden increases because of Program Change due to Agency
Discretion: No
Burden Increase Due to:
Burden decreases because of Program Change due to Agency
Discretion: No
Burden Reduction Due to:
Short Statement:
Annual Cost to Federal Government:
$3,530,745
Does this IC contain surveys, censuses, or employ
statistical methods? Yes Part B of Supporting Statement
Does this ICR request any personally identifiable
information (see OMB Circular No. A-130 for an
explanation of this term)? Please consult with your agency's
privacy program when making this determination.
Yes
Does this ICR include a form that requires a Privacy Act
Statement (see 5
U.S.C. §552a(e)(3) )? Please consult with your agency's privacy
program when making this determination.
No
Is this ICR related to the Affordable Care Act [Pub. L.
111-148 & 111-152]? Yes
Is this ICR related to the Dodd-Frank Wall Street Reform
and Consumer Protection Act, [Pub. L. 111-203]? No
Is this ICR related to the American Recovery and
Reinvestment Act of 2009 (ARRA)? No
Is this ICR related to the Pandemic Response?
No
Agency Contact: Jeffrey Zirger 404 639-7118
[email protected]