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

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920-1083 Nonsmoker Survey - Wave I	Form and Instruction	Modified	Available
Form 0920-1083 Nonsmoker Survey - Wave I	Form and Instruction	Modified	Repair queued
Form 0920-1083 Nonsmoker Survey - Wave H	Form and Instruction	Modified	Available
Form 0920-1083 Nonsmoker Survey - Wave H	Form and Instruction	Modified	Repair queued
Form 0920-1083 Nonsmoker Survey - Wave G	Form and Instruction	Modified	Available
Form 0920-1083 Nonsmoker Survey - Wave G	Form and Instruction	Modified	Repair queued
Form 0920-1083 Nonsmoker Survey - Wave F	Form and Instruction	Modified	Repair queued
Form 0920-1083 Nonsmoker Survey - Wave F	Form and Instruction	Modified	Repair queued
Form 0920-1083 Smoker Survey - Wave I	Form and Instruction	Modified	Available
Form 0920-1083 Smoker Survery - Wave I	Form and Instruction	Modified	Repair queued
Form 0920-1083 Smoker Survey - Wave H	Form and Instruction	Modified	Available
Form 0920-1083 Smoker Survery - Wave H	Form and Instruction	Modified	Repair queued
Form 0920-1083 Smoker Survey - Wave G	Form and Instruction	Modified	Available
Form 0920-1083 Smoker Survery - Wave G	Form and Instruction	Modified	Repair queued
Form 0920-1083 Smoker Survey - Wave F	Form and Instruction	Modified	Available
Form 0920-1083 Smoker Survery - Wave F	Form and Instruction	Modified	Repair queued
Form 0920-1083 Nonsmoker Survey - Wave E	Form and Instruction	Modified	Available
Form 0920-1083 Nonsmoker Survey - Wave E	Form and Instruction	Modified	Repair queued
Form 0920-1083 Smoker Survey - Wave E	Form and Instruction	Modified	Available
Form 0920-1083 Smoker Survey - Wave E	Form and Instruction	Modified	Repair queued
Form 0920-1083 Smoker Survey - Wave A	Form and Instruction	Modified	Available
Form 0920-1083 Smoker Survey - Wave A	Form and Instruction	Modified	Repair queued
Form 0920-1083 Nonsmoker Survey - Wave D	Form and Instruction	Modified	Available
Form 0920-1083 Non-smoker Survey - Wave D	Form and Instruction	Modified	Repair queued
Form 0920-1083 Nonsmoker Survey - Wave C	Form and Instruction	Modified	Available
Form 0920-1083 Non-smoker Survey - Wave C	Form and Instruction	Modified	Repair queued
Form 0920-1083 Nonsmoker Survey - Wave B	Form and Instruction	Modified	Available
Form 0920-1083 Non-smoker Survey - Wave B	Form and Instruction	Modified	Repair queued
Form 0920-1083 Nonsmoker Survey - Wave A	Form and Instruction	Modified	Available
Form 0920-1083 Non-smoker Survey - Wave A	Form and Instruction	Modified	Repair queued
Form 0920-1083 Smoker Suvey - Wave D	Form and Instruction	Modified	Available
Form 0920-1083 Smoker Survey - Wave D	Form and Instruction	Modified	Repair queued
Form 0920-1083 Smoker Survey - Wave C	Form and Instruction	Modified	Available
Form 0920-1083 Smoker Survey - Wave C	Form and Instruction	Modified	Repair queued
Form 0920-1083 Smoker Survey - Wave B	Form and Instruction	Modified	Available
Form 0920-1083 Smoker Survey - Wave B	Form and Instruction	Modified	Repair queued
Form 0920-1083 Screening and Consent	Form and Instruction	Modified	Available
Form 0920-1083 Screening and Consent	Form and Instruction	Modified	Repair queued
Attachment C-1. Changes to Waves A-I Screener Survey (004).docx	Supplementary Document	Uploaded 2022-09-30	Repair queued
privacy-narrative-form 08_05_22 OMB 0920_1083.pdf	Supplementary Document	Uploaded 2022-09-30	Repair queued
Attachment J. Source of Respondents for Each Wave of Data Collection.docx	Supplementary Document	Uploaded 2022-09-30	Repair queued
Attachment I-3. ABS Sample Postcard Reminders.pdf	Supplementary Document	Uploaded 2022-09-30	Repair queued
Attachment I-2. KnowledgePanel Email Invitation Reminders (005)_final.docx	Supplementary Document	Uploaded 2022-09-30	Repair queued
Attachment I-1. ABS Sample Invitation Letters.pdf	Supplementary Document	Uploaded 2022-09-30	Repair queued
Attachment H. Ipsos Privacy and Security Procedures.docx	Supplementary Document	Uploaded 2022-09-30	Repair queued
STARS_Project-Summary-0900f3eb81ccd0c4-9-9-2022-10_58_51.pdf	Supplementary Document	Uploaded 2022-09-30	Repair queued
Attachment F. KnowledgePanel Recruitment Procedures_.docx	Supplementary Document	Uploaded 2022-09-30	Repair queued
Attachment E-2. Changes to Wave A-I Nonsmoker Survey (006)_.docx	Supplementary Document	Uploaded 2022-09-30	Available
Attachment D-2. Changes to Waves A-I Smoker Survey_.docx	Supplementary Document	Uploaded 2022-09-30	Repair queued
Attachment B-1. 60-day Federal Register Notice, Docket No. CDC_2022-0071.pdf	Supplementary Document	Uploaded 2022-09-30	Repair queued
Attachment A-3. PPHF.pdf	Supplementary Document	Uploaded 2022-09-30	Repair queued
Attachment A-2. Familly Smoking Prevention & Tobacco Control Act.PDF	Supplementary Document	Uploaded 2022-09-30	Repair queued
Attachment A-1. Public Health Service Act.docx	Supplementary Document	Uploaded 2022-09-30	Available
SSB 2022 Part B_Evaluation ICR (002)_bcl_clean_8_24_22v2_final.docx	Supporting Statement B	Uploaded 2022-09-30	Repair queued
SSA_2022 Part A_Evaluation ICR (003) (002) Clean 8_24_22_1_final.docx	Supporting Statement A	Uploaded 2022-09-30	Repair queued

IC Document Collections

Information collection document groups

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

ICR Details

OMB Control No: 0920-1083	ICR Reference No: 202209-0920-012
Status: Historical Active	Previous ICR Reference No: 202204-0920-015
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-1083
Title: Extended Evaluation of the National Tobacco Prevention and Control Public Education Campaign
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/15/2023
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/30/2022
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2026	36 Months From Approved	03/31/2023
Responses	40,434	0	40,434
Time Burden (Hours)	9,308	0	9,308
Cost Burden (Dollars)	232,096	0	232,096

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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 Revision primarily encompasses changes in the content and wording of the survey instruments and does not involve burden or respondent edits.

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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

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 33491	06/02/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 59424	09/30/2022
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 19

table that charts list of burden

IC Title	Form No.	Form Name
Non-smoker Survey - Wave A	0920-1083	Nonsmoker Survey - Wave A
Non-smoker Survey - Wave B	0920-1083	Nonsmoker Survey - Wave B
Non-smoker Survey - Wave C	0920-1083	Nonsmoker Survey - Wave C
Non-smoker Survey - Wave D	0920-1083	Nonsmoker Survey - Wave D
Nonsmoker Survey - Wave E	0920-1083	Nonsmoker Survey - Wave E
Nonsmoker Survey - Wave F	0920-1083	Nonsmoker Survey - Wave F
Nonsmoker Survey - Wave G	0920-1083	Nonsmoker Survey - Wave G
Nonsmoker Survey - Wave H	0920-1083	Nonsmoker Survey - Wave H
Nonsmoker Survey - Wave I	0920-1083	Nonsmoker Survey - Wave I
Screening and Consent	0920-1083	Screening and Consent
Smoker Survery - Wave F	0920-1083	Smoker Survey - Wave F
Smoker Survery - Wave G	0920-1083	Smoker Survey - Wave G
Smoker Survery - Wave H	0920-1083	Smoker Survey - Wave H
Smoker Survery - Wave I	0920-1083	Smoker Survey - Wave I
Smoker Survey - Wave A	0920-1083	Smoker Survey - Wave A
Smoker Survey - Wave B	0920-1083	Smoker Survey - Wave B
Smoker Survey - Wave C	0920-1083	Smoker Survey - Wave C
Smoker Survey - Wave D	0920-1083	Smoker Suvey - Wave D
Smoker Survey - Wave E	0920-1083	Smoker Survey - Wave E

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ICR Summary of Burden

table that charts list of burden

	Total Approved	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:

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Annual Cost to Federal Government: $4,030,745

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

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Common Form ICR:  No

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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: 09/30/2022

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