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

Forms and Documents

Document Name	Status
Form 0920-1083 Nonsmoker Survey - Wave I (English and Spanish) Form and Instruction	Unchanged
Form 0920-1083 Nonsmoker Survey - Wave H (English and Spanish) Form and Instruction	Modified
Form 0920-1083 Nonsmoker Survey - Wave G (English and Spanish) Form and Instruction	Unchanged
Form 0920-1083 Nonsmoker Survey - Wave F (English and Spanish) Form and Instruction	Unchanged
Form 0920-1083 Smoker Survery - Wave I (English and Spanish) Form and Instruction	Unchanged
Form 0920-1083 Smoker Survery - Wave H (English and Spanish) Form and Instruction	Modified
Form 0920-1083 Smoker Survery - Wave G (English and Spanish) Form and Instruction	Unchanged
Form 0920-1083 Smoker Survery - Wave F (English and Spanish) Form and Instruction	Unchanged
Form 0920-1083 Nonsmoker Survey - Wave E (English and Spanish) Form and Instruction	Unchanged
Form 0920-1083 Smoker Survey - Wave E (English and Spanish) Form and Instruction	Unchanged
Form 0920-1083 Smoker Survey - Wave A (English and Spanish) Form and Instruction	Unchanged
Form 0920-1083 Non-smoker Survey - Wave D (English and Spanish) Form and Instruction	Unchanged
Form 0920-1083 Non-smoker Survey - Wave C (English and Spanish) Form and Instruction	Unchanged
Form 0920-1083 Non-smoker Survey - Wave B (English and Spanish) Form and Instruction	Unchanged
Form 0920-1083 Non-smoker Survey - Wave A (English and Spanish) Form and Instruction	Unchanged
Form 0920-1083 Smoker Survey - Wave D (English and Spanish) Form and Instruction	Unchanged
Form 0920-1083 Smoker Survey - Wave C (English and Spanish) Form and Instruction	Unchanged
Form 0920-1083 Smoker Survey - Wave B (English and Spanish) Form and Instruction	Unchanged
Form 0920-1083 Screening and Consent (English and Spanish) Form and Instruction	Unchanged
Attachment I-1. 2022 NTEC Smoker Survey Questionnaire_Additions Highlighted in Blue Font.pdf Supplementary Document	2022-05-02
Attachment I-1. 2022 NTEC Smoker Survey Questionnaire.pdf Supplementary Document	2022-05-02
Attachment I-2 OMB_ 0920-1083_Crosswalk_Programming_Instrctions_.docx Supplementary Document	2022-05-02
Change Request Summary 0920_1083_bcl_rm_2_23_clean_5_2_22.docx Justification for No Material/Nonsubstantive Change	2022-05-02
Non_Sub Change Crosswalk 04JUN2021.docx Supplementary Document	2021-06-07
2020 NTEC Change Request 0920_1083 _9_23_20_a.docx Justification for No Material/Nonsubstantive Change	2021-06-07
684_NTEC.pdf Supplementary Document	2019-10-07
Privacy Narrative PDF OMB 0920_1083_12_19_18 signed 09-12-19.pdf Supplementary Document	2019-10-07
Attachment J. Source of Respondents for Each Wave of Data Collection.docx Supplementary Document	2019-10-07
Attachment I-3. ABS Sample Postcard Reminders.pdf Supplementary Document	2019-10-07
Attachment I-2. KnowledgePanel Email Invitation Reminders.doc Supplementary Document	2019-10-07
Attachment I-1. ABS Sample Invitation Letters.pdf Supplementary Document	2019-10-07
Attachment H. GfK-Ipsos Privacy and Security Procedures.doc Supplementary Document	2019-10-07
Attachment G. RTI IRB Approval Notice.pdf Supplementary Document	2019-10-07
Attachment F. KnowledgePanel Recruitment Procedures.doc Supplementary Document	2019-10-07
Attachment E-3. Changes to Wave A-I Nonsmoker Survey 12-5-18.docx Supplementary Document	2019-10-07
Attachment D-3. Changes to Wave A-I Smoker Survey Updated.docx Supplementary Document	2019-10-09
Attachment B-1. 60-Day FRN Published 4-23-19.pdf Supplementary Document	2019-10-07
Attachment A-3. PPHF.pdf Supplementary Document	2019-10-07
Attachment A-2. Familly Smoking Prevention & Tobacco Control Act.PDF Supplementary Document	2019-10-07
Attachment A-1. Public Health Service Act.doc Supplementary Document	2019-10-07
Part B_Evaluation ICR_6-10-19.docx Supporting Statement B	2019-10-07
Part A_Evaluation ICR_6-10-19 final.docx Supporting Statement A	2019-10-07

IC Document Collections

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

ICR Details

OMB Control No: 0920-1083	ICR Reference No: 202204-0920-015
Status: Received in OIRA	Previous ICR Reference No: 202106-0920-001
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-1083-22DG
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: 05/02/2022

	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

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 05/02/2022

---