Information Collection

Nonsmoker Survey - Wave E (English and Spanish)

IC 228674 under ICR 202106-0920-001 · OMB 0920-1083.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1083 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1083 Nonsmoker Survey - Wave E (English and Spanish)	Form and Instruction
Form 0920-1083 Nonsmoker Survey - Wave E Nonsmoker Survey - Wave E (English and Spanish)	Form and Instruction
Form 0920-1083 Nonsmoker Survey - Wave E Spanish Nonsmoker Survey - Wave E (English and Spanish)	Form and Instruction
Form 0920-1083 Nonsmoker Survey Wave E_English 04JUN2021 Nonsmoker Survey - Wave E (English and Spanish)	Form and Instruction
Form 0920-1083 Nonsmoker Survey Wave E_Spanish 04JUN2021 Nonsmoker Survey - Wave E (English and Spanish)	Form and Instruction
0920-1083 Nonsmoker Survey - Wave E Attachment E-1. Waves A-I Nonsmoker Survey Screenshots 12-5-18 (English).pdf	Form and Instruction
0920-1083 Nonsmoker Survey - Wave E Attachment E-1. Waves A-I Nonsmoker Survey Screenshots 12-5-18 (English).pdf	Form and Instruction
0920-1083 Nonsmoker Survey - Wave E Spanish Attachment E-2. Waves A-I Nonsmoker Survey Screenshots 6-10-19 (Spanish).pdf	Form and Instruction
0920-1083 Nonsmoker Survey - Wave E Spanish Attachment E-2. Waves A-I Nonsmoker Survey Screenshots 6-10-19 (Spanish).pdf	Form and Instruction
0920-1083 Nonsmoker Survey Wave E_English 04JUN2021 Waves A-I NonSmoker English.docx	Form and Instruction
0920-1083 Nonsmoker Survey Wave E_English 04JUN2021 Waves A-I NonSmoker English.docx	Form and Instruction
0920-1083 Nonsmoker Survey Wave E_Spanish 04JUN2021 ATTA~8MX.PDF	Form and Instruction
0920-1083 Nonsmoker Survey Wave E_Spanish 04JUN2021 ATTA~8MX.PDF	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Nonsmoker Survey - Wave E (English and Spanish)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-1083		Yes	Yes	Fillable Fileable
Form and Instruction	0920-1083		Yes	Yes	Fillable Fileable
Form and Instruction	0920-1083	NA	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1083	NA	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 833

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	833	833
Annual IC Time Burden (Hours)	277	277
Annual IC Cost Burden (Dollars)	9,721	9,721

Documents for IC

table that charts IC Documents
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.

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