Information Collection

Smoker Survey - Wave C (English and Spanish)

IC 217189 under ICR 202204-0920-015 · 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⚠️ Notice: This information collection may be referencing outdated material.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 Smoker Survey - Wave C (English and Spanish)	Form and Instruction
0920-1083 Smoker Survey - Wave C Attachment D-1. Waves A-I Smoker Survey Screenshots 12-5-18 (English)V2.docx	Form and Instruction
0920-1083 Smoker Survey - Wave C Attachment D-1. Waves A-I Smoker Survey Screenshots 12-5-18 (English)V2.docx	Form and Instruction
0920-1083 Smoker Survey -- Wave C Spanish Attachment D-2. Waves A-I Smoker Survey Screenshots 6-10-19 (Spanish).docx	Form and Instruction
0920-1083 Smoker Survey -- Wave C Spanish Attachment D-2. Waves A-I Smoker Survey Screenshots 6-10-19 (Spanish).docx	Form and Instruction
0920-1083 Smoker Survey Wave C_English 04JUN2021 Waves A-I Smoker English.docx	Form and Instruction
0920-1083 Smoker Survey Wave C_English 04JUN2021 Waves A-I Smoker English.docx	Form and Instruction
0920-1083 Smoker Survey Wave C_Spanish 04JUN2021 Waves A-I Smoker Spanish.docx	Form and Instruction
0920-1083 Smoker Survey Wave C_Spanish 04JUN2021 Waves A-I Smoker Spanish.docx	Form and Instruction

IC Title:

Smoker Survey - Wave C (English and Spanish)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-1083	Smoker Survey - Wave C	Attachment D-1. Waves A-I Smoker Survey Screenshots 12-5-18 (English)V2.docx		Yes	Yes	Fillable Fileable
Form and Instruction	0920-1083	Smoker Survey -- Wave C Spanish	Attachment D-2. Waves A-I Smoker Survey Screenshots 6-10-19 (Spanish).docx		Yes	Yes	Fillable Fileable
Form and Instruction	0920-1083	Smoker Survey Wave C_English 04JUN2021	Waves A-I Smoker English.docx	NA	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1083	Smoker Survey Wave C_Spanish 04JUN2021	Waves A-I Smoker Spanish.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,667

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	1,667	1,667
Annual IC Time Burden (Hours)	556	556
Annual IC Cost Burden (Dollars)	19,462	19,462

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.