Information Collection

Nonsmoker Survey - Wave I (English and Spanish)

IC 237915 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⚠️ Notice: This information collection may be referencing outdated material.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 Nonsmoker Survey - Wave I (English and Spanish)	Form and Instruction
0920-1083 Nonsmoker Survey - Wave I Attachment E-1. Waves A-I Nonsmoker Survey Screenshots 12-5-18 (English).pdf	Form and Instruction
0920-1083 Nonsmoker Survey - Wave I Attachment E-1. Waves A-I Nonsmoker Survey Screenshots 12-5-18 (English).pdf	Form and Instruction
0920-1083 Nonsmoker Survey - Wave I Spanish Attachment E-2. Waves A-I Nonsmoker Survey Screenshots 6-10-19 (Spanish).pdf	Form and Instruction
0920-1083 Nonsmoker Survey - Wave I Spanish Attachment E-2. Waves A-I Nonsmoker Survey Screenshots 6-10-19 (Spanish).pdf	Form and Instruction
0920-1083 Nonsmoker Survey Wave I_English 04JUN2021 Waves A-I NonSmoker English.docx	Form and Instruction
0920-1083 Nonsmoker Survey Wave I_English 04JUN2021 Waves A-I NonSmoker English.docx	Form and Instruction
0920-1083 Nonsmoker Survey Wave I_Spanish 04JUN2021 ATTA~8MX.PDF	Form and Instruction
0920-1083 Nonsmoker Survey Wave I_Spanish 04JUN2021 ATTA~8MX.PDF	Form and Instruction

IC Title:

Nonsmoker Survey - Wave I (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	Nonsmoker Survey - Wave I	Attachment E-1. Waves A-I Nonsmoker Survey Screenshots 12-5-18 (English).pdf		Yes	Yes	Fillable Fileable
Form and Instruction	0920-1083	Nonsmoker Survey - Wave I Spanish	Attachment E-2. Waves A-I Nonsmoker Survey Screenshots 6-10-19 (Spanish).pdf		Yes	Yes	Fillable Fileable
Form and Instruction	0920-1083	Nonsmoker Survey Wave I_English 04JUN2021	Waves A-I NonSmoker English.docx	NA	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1083	Nonsmoker Survey Wave I_Spanish 04JUN2021	ATTA~8MX.PDF	NA	Yes	Yes	Fillable Fileable

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.