Smoker Survey - Wave D (English and Spanish)

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

OMB: 0920-1083

IC ID: 217190

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Smoker Survey - Wave D (English and Spanish)
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-1083 Smoker Suvey - Wave D 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 D 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 D_English 04JUN2021 Waves A-I Smoker English.docx NA Yes Yes Fillable Fileable
Form and Instruction 0920-1083 Smoker Survey Wave D_Spanish 04JUN2021 Waves A-I Smoker Spanish.docx NA Yes Yes Fillable Fileable

Health Illness Prevention

 

1,667 0
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1,667 0 0 0 0 1,667
Annual IC Time Burden (Hours) 556 0 0 0 0 556
Annual IC Cost Burden (Dollars) 19,454 0 0 0 0 19,454

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